Preamble

The House met at half-past Two o'clock

PRYERS

[Mr. SPEAKER in the chair]

PRIVATE BUSINESS

METALS SOCIETY BILL [Lords]

Read the Third time and passed, with Amendments.

TYNESIDE METROPOLITAN RAILWAY BILL

Order for Third Reading read.

(Queen's Consent, on behalf of the Crown, signified.)

Read the Third time and passed.

KING'S LYNN CORPORATION BILL [Lords]

DEE AND CLWYD RIVER AUTHORITY BILL

As amended, considered; to be read the Third time.

Oral Answers to Questions — EMPLOYMENT

Industrial Relations References

Mr. Ashton: asked the Secretary of State for Employment what is his policy with regard to making references to the National Industrial Relations Court.

The Secretary of State for Employment (Mr. Maurice Macmillan): I cannot do so in general terms since I need to consider all the circumstances of each particular situation.

Mr. Ashton: The Minister has not used the Act for almost eight months. How will he get out of the dilemma of the Chrysler works when he knows that, if he uses the Act, matters will be made worse and that, at the same time, something must be done to settle the dispute? Would it not be better to scrap the Act altogether and return to our old system of industrial relations?

Mr. Macmillan: If the hon. Gentleman is referring to the power to intervene in an emergency, I have not used the Act because the circumstances have

not arisen, nor does the Act give power to intervene in the Chrysler dispute.

Miss Holt: Are not many unions depriving their members of benefit by not making use of the Act?

Mr. Macmillan: At least one union has gained considerably by using the Act. The use made of the Act by the Association of Scientific, Technical and Managerial Staff, although it is not registered, has been of considerable benefit to its members in matters of recognition.

Mr. Greville Janner: Is not the reason why the Minister has not invoked his emergency powers under the Act that it is recognised by both sides of industry that the use of these powers generally does far more harm than good?

Mr. Macmillan: I have invoked the emergency powers under the Act.

Mr. Janner: Once.

Mr. Macmillan: There has not been an occasion so to do since then.

Unemployed Workers (Europe)

Mr. Meacher: asked the Secretary of State for Employment if he will publish the information available to him from international sources concerning the age distribution of unemployed workers in major European countries.

The Minister of State, Department of Employment (Mr. R. Chichester-Clark): As the reply contains tables of figures, I will, with permission, circulate a statement in the OFFICIAL REPORT.

Mr. Meacher: Is the Minister aware that Sweden protects older workers who cannot regain employment through the right of regional labour board officers to require companies to take on more such workers where, according to the personnel returns, a firm is not taking its fair share? Will he seriously consider introducing such a desirable system in this country?

Mr. Chichester-Clark: The view of successive Governments in this country has been that the older worker should not be regarded as a protected species but should be able to compete for work on his own merit.

Mr. Sydney Chapman: Will my hon. Friend consider publishing these figures, so that they can be used as a national comparison, and also figures for the


regions? Will he make regular statistics available to the House?

Mr. Chichester-Clark: I will consider what my hon. Friend has said but I warn him that there are dangers in trying to make comparisons. The comparisons I have been able to obtain with European countries are not valid because our figures are not comparable with those of European countries which are based on the EEC Labour Force Survey.

Following is the information:

TABLE 1


PERCENTAGE DISTRIBUTION OF UNEMPLOYED PERSONS BY AGE GROUPS


Males and Females—Spring 1971



Germany
France
Italy
Belgium


Age groups
Per cent.
Per cent.
Per cent.
Per cent.


Under 20
8·4
16·3
26·0
N/A


Over 20 but under 25
12·3
21·2
29·8
18·8


Over 25 but under 35
23·3
16·3
19·2
20·2


Over 35 but under 45
21·4
14·8
12·1
14·2


Over 45 but under 55
16·2
14·4
8·6
15·1


Over 55 but under 60
9·3
7·1
3·3
14·1


60 and over
8·6
10·0
0·9
11·3


Total
100·0
100·0
100·0
100·0

Source: "Statistiques Sociales—3–1972" EEC Labour Force Survey 1971, published by Statistical Office of the European Communities.

Note: The EEC Labour Force Survey assesses unemployment on the basis of a questionnaire addressed to a large sample of households. This basis and the definitions used, including those of employment and unemployment, differ considerable from those used in British unemployment statistics—and the figures in Table 1 and Table 2 (below) are not fully comparable.

TABLE 2


PERCENTAGE DISTRIBUTION OF UNEMPLOYED PERSONS BY AGE GROUPS


Males and Females—January 1973


Age groups
Great Britain Per cent.


Under 20
14·4


20 and over but under 25
15·9


25 and over but under 35
17·7


35 and over but under 45
13·8


45 and over but under 55
14·6


55 and over but under 60
8·2


60 and over
15·3


Total
100·0

Source: Department of Employment Gazette.

Note: The numbers include only people who register as unemployed. They include school leavers and adult students but exclude those temporarily stopped.

Northern Region

Mr. Horam: asked the Secretary of State for Employment what was the percentage unemployed—seasonally adjusted and excluding school leavers and adult students—in the Northern Region and Great Britain in April 1970 and April 1973.

The Under-Secretary of State for Employment (Mr. Dudley Smith): In the Northern Region the unemployment percentages were 4·6 per cent. in April 1970 and 4·8 per cent. in April 1973. In Great Britain the figures were 2·5 per cent. in April 1970 and 2·7 per cent. in April 1973.

Mr. Horam: Do not these figures bear out with almost clinical precision the argument made repeatedly from the Opposition benches yesterday that there has been no relative improvement in the employment position in the Northern Region by comparison with the rest of the country? Does the Minister seriously believe that there will be an improvement within the life of this Parliament if the Government continue their present policies?

Mr. Smith: Yes, I think that there will be an improvement. The hon. Gentleman is unfair. The important thing is to reduce unemployment, in whatever part of the country. Unemployment in the Northern Region has fallen considerably. In March last year the seasonally adjusted rate was 6·3 per cent., compared with 4·7 per cent. now. On Tyneside, which includes the hon. Gentleman's constituency, unemployment has fallen by more than 5,000 in the last 12 months.

Mr. R. W. Elliott: Will my hon. Friend take due note that in the Northern Region it is fully appreciated that six-and-a-half years of Labour stagnation of the economy with rapidly rising unemployment cannot be overcome overnight? Does he agree that job vacancies would be a much better yardstick, and will he give us an idea of them?

Mr. Smith: Yes, my hon. Friend is right; job vacancies are by far the best yardstick available. The number of vacancies has more than doubled in the past year, and there are two and a half


times as many vacancies for male employees as there were in May 1972. There are now more than 5,000 more unfilled vacancies in the Northern Region than there were in April 1970 when the Labour Party was in power.

Mr. Dormand: Will the Minister point out to his right hon. Friend the Secretary of State for Education and Science the inadequacy of maintenance allowances? More children in the South than in the North are remaining at school after reaching school leaving age. A great contribution would be made if the Secretary of State ensured that the maintenance allowances were sufficient to meet the needs of children who stay on longer at school.

Mr. Smith: The hon. Gentleman knows that that is not a matter for me. While I do not necessarily accept what he says, I will bring it to the attention of my right hon. Friend.

Disabled Persons

Mr. Ashley: asked the Secretary of State for Employment what recent representations he has received concerning his policy towards improving the employment prospects of disabled people; and what replies he has sent.

Mr. Dudley Smith: My right hon. Friend is in constant touch with individuals and organisations concerned with these matters, including the National Advisory Council on the Employment of the Disabled, on a wide variety of topics. I shall be happy to write to the hon. Member giving details of any particular representations he may have in mind, and of the replies that we have sent.

Mr. Ashley: In his consultative document the Minister has now recognised our criticism of the existing scheme for helping disabled people, and I welcome that. Is he aware, however, that the best solution is to make all employers pay for a quota whether or not they employ disabled people so that the shoe is neatly placed under the foot? Instead of disabled people asking employers for work, employers would then be asking disabled people to work for them and those employers who would not give them work would properly be penalised.

Mr. Smith: I am sure the hon. Gentleman would agree that the document is very fair concerning the quota and examines a wide variety of possibilities, including tougher enforcement and financial incentives to employers to employ disabled people. I do not rule out the suggestion which he makes, which can be another factor to be considered. The important thing is to get the right consensus as to what should be done and to make it more effective in terms of the employment of disabled people.

Mr. Marten: Could not more encouragement be given to local authorities to persuade them to increase the number of disabled people they employ?

Mr. Smith: Yes, Sir, and we are all the time endeavouring to make sure that public sources fulfil their quotas and employ as many disabled people as possible. My hon. Friend will be glad to know that unemployment among the disabled fell substantially during the last year, from 91,063 to 77,360. The figure is still too high, and the more we can encourage both public and private sources to take action in this respect the better.

Mr. Elystan Morgan: The hon. Gentleman referred to tougher enforcement. In what year did the last prosecution of an employer under the 1944 Act take place?

Mr. Smith: The last one, speaking from memory, was some years ago—I think in the early 1960s or late 1950s. We have debated this matter in the Welsh Grand Committee. Successive Governments have taken the view that persuasion is better than coercion. It may be that public opinion now feels that there should be greater coercion. [HON. MEMBERS: "Hear, hear".] Hon. Members may take that view, but this has been spelt out conclusively in the quota document, and it is a matter for detailed consideration. There are those who believe that tougher penalties will not lead to the employment of more disabled people.

Sir B. Rhys Williams: Does my hon. Friend agree that the best way to encourage disabled people to seek employment is to introduce a disability income which would enable them to be independent even when they can only earn low wages? Since the employment of


the disabled is only one aspect of the problem, does my hon. Friend agree to collaborate with the Department of Health and Social Security and to produce a Green Paper setting out the Government's whole policy for helping the disabled?

Mr. Smith: That is a little wide of my remit, but all these matters relating to the employment of the disabled are under consideration and we are in contact with the Department of Health and Social Security on matters in which our responsibilities involve disabled people.

Mr. Prentice: Will the hon. Gentleman confirm the 1972 figure of about 9,000 firms in breach of the law by being below the quota without permission from his Department? Does he not feel that this is an intolerable situation? We waited a long time for the consultative documents and the hon. Gentleman mentioned the question of opinion-forming, but what are the other alternatives? What sort of timetable does he envisage, and what specific proposals has he to deal with the problem?

Mr. Smith: The right hon. Gentleman will know that the law in this respect has been in operation for 30 years and one does not change it overnight. We have given a reasonable period for consultation and a number of opinions will be flowing in. I hope that by the end of the year we shall be able to form some conclusion on the quota system. This is tied up with the other aspect of the problems of the disabled. It is true that there are a number of firms which do not fulfil their quota obligations or get exemption permits, but there are difficulties in enforcement and sometimes difficulty in getting the right sort of disabled people into employment because they are not suitable for specific jobs.

Self-Employed Persons

Mr. Norman Lamont: asked the Secretary of State for Employment what estimate his Department has made of the number of self-employed people not so recorded in the official statistics.

Mr. Dudley Smith: The main source of information about the numbers of employers and self-employed people is the Census of Population updated annually

by a sample of national insurance cards. The total for June 1971, the latest available date, was 1,791,000. No other official estimates are made.

Mr. Lamont: Is the Minister aware that the movements in the official figures of self-employed and unemployed do not correspond with the movements in the labour force as defined officially? One calculation is that there is an underestimate of the self-employed to the extent of 250,000 people. Is it not an unsatisfactory state of affairs that estimates of the numbers of the self-employed should have to depend on the census once every four years? What light is shed on the official figures in the construction industry by the experience of the issue of tax exemption certificates?

Mr. Smith: No statistical source is infallible. I am aware that some observers feel that official statistics are under-recorded, but as well as the Census of Population there is an annual undating which takes into account national insurance cards, and data have recently been provided to us by the Inland Revenue. This again should help our officials in estimating the number of self-employed more accurately, but it comes down to a question of the honesty of the individual when completing his census form. If an individual does not state that he is self-employed, it is sometimes difficult to trace the information.

Mr. Heffer: During the Second Reading debate on the Labour-Only Sub-Contracting Bill which I introduced to deal with the lump—a Bill which unfortunately did not get through—the Minister said that the Government intended to institute an inquiry into self-employment in the building industry and its effects on the total situation. Can he say what steps the Government are now taking on this topic? Are they pursuing this matter, have they any plans to deal with it, and what do they intend to do about the situation—or has their action so far been merely a lot of words?

Mr. Smith: No, Sir, I understand that that is not the situation, but these are mainly questions for my right hon. and learned Friend the Secretary of State for the Environment. Discussions are taking place within the industry's national joint


council and within the economic development committee for the building industry. I understand that the EDC's working party on employment problems yesterday considered a paper on this subject prepared by the National Economic Development Office. Progress is being made and I am sure that the hon. Gentleman will look forward to further results.

Worker Participation

Mr. Haselhurst: asked the Secretary of State for Employment whether, in any amendment of the Industrial Relations Act, he will propose that employees as well as shareholders are members of their company and should be provided with the directors' report including a survey of the company's industrial relations.

Mr. Kinsey: asked the Secretary of State for Employment whether, in any amendment of the Industrial Relations Act, he will propose making it mandatory for companies to report annually to their employees and shareholders about their implementation of the Code of Industrial Relations Practice.

Mr. Maurice Macmillan: I have some sympathy with the thoughts underlying these suggestions as regards employees. I will certainly consider them in the course of our current study of worker participation. Suggestions regarding a company's obligations to its shareholders are, of course, for my right hon. Friend the Secretary of State for Trade and Industry.

Mr. Haselhurst: I thank my right hon. Friend for that answer. Would this not be a useful start towards a fuller programme of participation by employees in a company? Surely it is about time that at least a small step was taken in this direction so that employees may feel that they have as much say as the shareholders in their company.

Mr. Macmillian: Yes, I think that this is very much the thinking behind our commitment, not least at the European summit and in the proposals which we discussed in the Council of Ministers at Brussels the other day. It is important that steps should be taken in this direction, but it is equally important that the proposals should be properly discussed

with those concerned. We should not necessarily slavishly follow the European pattern. We may decide on a pattern of development to suit our own particular needs.

Mr. Cant: Will the right hon. Gentleman ensure that when a registered union, such as the Steel Industry Management Association, approaches the NIRC for financial information about cost, profits and prices of plant in the steel industry, it will be given that information?

Mr. Macmillan: It would be improper for me to say one way or the other what will happen when anyone approaches a court.

Mr. Selwyn Gummer: Will my right hon. Friend take some action while discussing worker participation by encouraging firms to give this information freely, because many firms do not do so and could give it if my right hon. Friend reminded them forcibly that this is part of their job as decent employers?

Mr. Macmillan: This is very much part of the Code of Industrial Relations Practice, and I hope that both sides of industry will do all they can to implement the code.

Mr. Prentice: Will the right hon Gentleman confirm that the Government have on their agenda at least three possible ways, if they choose, of promoting the extension of worker participation? One is the possible amendment of the Industrial Relations Act. The second is the proposed new Companies Act. The third is the initiative emanating from the Commission in Brussels Can the right hon. Gentleman give us some idea of the Government's timetable of policy-making under those three heads? Are we likely to have a statement of Government policy before the Summer Recess, since it would be useful for the promotion of discussion throughout the country?

Mr. Macmillan: I agree, not least because of the demand for a European timetable, that it is necessary for ideas to be discussed quickly with those concerned and for the Government's position to be set out. This is a matter for consultation between the unions and employers. I should not like it to be thought that we were putting forward ideas without consultation.
I confirm that there are three aspects: the Code of Industrial Relations Practice under the Industrial Relations Act, company law, and the action being taken in the European context.

Mr. Scott-Hopkins: Is my right hon. Friend aware that the legislation emanating from the Commission in Brussels is fairly far advanced and has been discussed in working papers of the European Assembly and its committees? In framing his policy, will my right hon. Friend ensure that there is co-ordination with those proposals so that there is no clash of interest between our legislation and that proposed by the Commission?

Mr. Macmillan: I take that point. However, the ideas put forward by the Commission are not wholly acceptable to sonic of the other countries involved in the Community. It is important to remember that we are discussing in general terms employee participation, and it must be recognised that this extends to white-collar and staff workers as well as to manual workers on the shop floor.

Industrial Safety (Robens Report)

Mr. Marten: asked the Secretary of State for Employment what proposals he has for legislation to deal with the Robens Report.

Mr. Tom King: asked the Secretary of State for Employment if he will now make a statement on the Government's intentions for implementing the recommendations of the Robens Report on Safety and Health at Work.

Mr. Holland: asked the Secretary of State for Employment if he will now make a statement on the Government's intentions for implementing the recommendations of the Robens Report on industrial safety.

Mr. Adam Butler: asked the Secretary of State for Employment if he will now make a statement on the Government's intentions for implementing the proposals of the Robens Report on Health and Safety at Work.

Mr. Maurice Macmillan: I would refer my hon. Friends to the statement made in this House by my hon. Friend

the Under-Secretary of State on Monday 21st May.—[Vol. 857, c. 74–84.]

Mr. Marten: In view of the many points raised during the debate on the motion of the hon. Member for Bedwellty (Mr. Kinnock) on this subject, may I ask whether we are to have an opportunity to discuss matters arising out of the consultations promised between the CBI and the TUC, especially as regards the Factories Inspectorate?

Mr. Macmillan: Any question of debate is one for my right hon. Friend the Leader of the House. In any case it would be wise to wait until the House has had an opportunity to see the consultative proposals, which I hope will be available by about the end of the month.

Mr. Kinnock: Is the right hon. Gentleman aware that there is already widespread dissatisfaction among trade unionists, doctors, lawyers and apparently even civil servants about the indication which the Under-Secretary gave that he accepts the central premise of voluntarism in health and safety arrangements embodied in the Robens Report? Before instituting legislation, will the right hon. Gentleman consider the possibility of trying to ensure that comprehensive health and safety laws are stringently enforced, rather than merely accepting the despairing and superficial contents of the Robens Report?

Mr. Macmillan: I do not accept that the Robens Report was either despairing or superficial. Nor do I believe that prevention is necessarily worse than cure. Nor do I accept that the enforcement procedures that we are proposing have fewer teeth than the ones now there. Under the arrangements that we put forward the inspectors will be able to secure more rapid improvements by using improvement notices or the possibility of closing down operations in cases of acute danger. We intend to provide stiffer financial penalties for offenders. There is no question of substituting codes of practice for regulations. There will be a considerable area where statutory requirements are clearly needed, and these will be retained and strengthened if necessary.

Mr. Holland: Will my right hon. Friend accept that the CBI and the TUC are not the only bodies in industry which


can make a valuable contribution? In drafting the legislation, will he avoid the twin pitfalls of a narrow base and selective application?

Mr. Macmillan: Yes. It is important to recognise that there are a number of other people involved, not least because of the Robens Report, in which one of the main objects of unification was to avoid the confusion that the general public has had in dealing with dangers to health and safety not only for people at work but for those surrounding places of work as a result of activities carried on in factories and other establishments.

Mr. Molloy: Is the right hon. Gentleman prepared to look at the Adjournment debate on the sweat-shop activities in greater London, in which he will discover reference made to the paucity of inspectors which allows the growth of sweat shops with increasing danger to life and limb of those working in them?

Mr. Macmillan: I will look at that debate again. The number of factories inspectors which may be required in the future is one of the major questions that the commission will have to deal with when it is established.

Mr. Adam Butler: Does my right hon. Friend intend to follow the Robens recommendation about the need for a statutory obligation on employers to consult their workpeople? Does he agree that the shop floor has a great deal to contribute in this matter? Will he consider setting up some form of statutory factory safety committees?

Mr. Macmillan: I will consider that. It is important to recognise that the Government have accepted one of the major points in the Robens Report, that it is essential to involve workpeople in conditions about safety and health at work. I agree that the consultations which my hon. Friend suggests should be undertaken.

Mr. Harold Walker: Does the right hon. Gentleman recognise that his hon. Friend the Member for Banbury (Mr. Marten) has put his finger on one of the central anxieties arising from the statement on 21st May by the Under-Secretary of State? I refer, of course, to the problems arising from expanding the scope of legislation to cover all those in employ-

ment and the public who are at risk as well without a commitment to increase the size of the inspectorate. This is bound to impose on the inspectorate an intolerably increased burden which will be borne satisfactorily only if the inspectorate is expanded or by introducing a system of worker safety representatives such as that advocated by a number of my right hon. and hon. Friends.

Mr. Macmillan: I do not deny the value of what Opposition Members have put fonward. But the hon. Gentleman has mistaken the point, which is that the authority should be centralised. This is achieved by bringing under the aegis of one central authority the existing inspectorate—factories, mines and alkali. No extra work will be put on the organisation. It is simply a matter of getting its work organised more coherently. There will be some savings. There will be a greater capacity and ability in terms of centralised research and so on and a greater capacity to consult and to share expertise.

Young Persons (Birmingham)

Mr. Carter: asked the Secretary of State for Employment what is the latest figure for unemployment amongst under-18s in Birmingham.

Mr. Dudley Smith: Five hundred and seventy-one young people were registered as unemployed in Birmingham on 14th May.

Mr. Carter: Is the hon. Gentleman aware that the figure is much less than it was last year? Large numbers—[Interruption.] It is nevertheless far too high. Is he aware that a growing number of school leavers are having to spend long periods unemployed before finding employment? What action does he propose to take to ensure that school leavers go straight into jobs and do not spend three or four months serving apprenticeships in the dole queue?

Mr. Smith: That is exactly the kind of action that the Government have been taking. Employment prospects for young people in the Birmingham area are good. There is no denying that. I have quoted the figure of 571 young people unemployed, but there are now 3,103 vacancies for them, which represents 2,000 more than a year ago.

Inflammable Materials (Fire Risk)

Mr. Nicholas Edwards: asked the Secretary of State for Employment whether, in his consultations on the recommendations of the Robens Report on Health and Safety at Work, special attention will be paid to the increasing fire risk in factories through use of inflammable materials.

Mr. Dudley Smith: The proposals for legislation on health and safety at work, about which my right hon. Friend will shortly be consulting interested organisations, will include provisions concerning control of fire risks arising from the use of flammable materials.

Mr. Edwards: Is my hon. Friend aware that, while consultations are of importance, the risks are present now? What action does he intend to take while consultations proceed to reduce the amount of inflammable materials used and to reduce the hazards?

Mr. Smith: I am glad to tell my hon. Friend that new regulations on this subject will come into force later this month. For the first time there will be a major code of regulations dealing with the storage, handling and use of dangerously flammable liquids and gases. It is estimated that in all about 200,000 premises will be covered. This is a useful step in the interim before the implementation of the Robens proposals.

Mr. Kinnock: Does the hon. Gentleman recognise that, by announcing in answer to his hon. Friend that new regulations are necessary to control fire hazards, he destroys one of the central presumptions of the Robens Report—namely, that we need less regulation? Is not his answer a condemnation of the present self-regulatory system?

Mr. Smith: No, I do not accept that. No one has ever pretended that under the Robens recommendations there will not be regulations. It is a question of better self-policing and rational use of forces. The regulations that I have mentioned will be harmonised with the other regulations which will be taken into account if and when the Robens proposals become law.

Vacancies

Mr. Rost: asked the Secretary of State for Employment what is the ratio of people registered as unemployed to notified unfilled vacancies in each region; and how this position compares with the same period a year ago.

Mr. Dudley Smith: The figures show a considerable improvement in all regions.
As the reply contains a table of figures I will, with permission, circulate it in the OFFICIAL REPORT.

Mr. Rost: The latest figures show the dramatic success of the Government's economic policy. But should they not also be read as a serious warning that rapid and sustained growth in our economy will be maintained only if we get more mobility of labour? Will my hon. Friend tell us what he will do to ensure that more people are encouraged to move to jobs as well as providing more jobs where they are needed?

Mr. Smith: My hon. Friend has made a valuable point. As he knows, the Government provide assistance towards the expenses of those living away from home and towards the costs of household removal under the Employment Transfer Scheme. The rates of grants and allowances are currently under review and we hope to make an announcement when the review is complete. We are also considering what more can be done to encourage the mobility of labour. It is not always easy, because some people are reluctant to move to different areas. However, we pay constant attention to this matter in an endeavour to try to ease the situation. I am glad that there has been this uniform fall in unemployment throughout the various regions, and there are signs that mobility is improving.

Mr. Loughlin: When the hon. Gentleman circulates his figures in the OFFICIAL REPORT, may I ask him to include the ratios for 1970? Will he also stop congratulating the Government on having produced 1 million unemployed and on having gradually reduced that number?

Mr. Smith: We are a long way from the 1 million unemployed. In a large number of regions, including the one I mentioned in a previous answer, there are now more vacancies available than


during the time of the Labour Government. The ratio of numbers unemployed to unfilled vacancies has moved from 4·5:1 a year ago to 1·5:1 at the present time. That is a considerable achievement and improvement by anybody's standards.

Dame Irene Ward: May I ask my hon. Friend to repeat the very good figures for the Northern Region so that we can then, I hope, impress on the Opposition the improvements that we are making, because they do not seem to have the brains to understand what is happening?

Mr. Smith: One would wish that there were a little more enthusiasm from the Opposition for the improvements that are taking place, particularly in difficult areas like the North. The May ratio of people unemployed to unfilled vacancies in the North now 3·5:1 compared with 10·2:1 a year ago.

Mr. Heffer: Will the hon. Gentleman, during his period of self-congratulation, admit that the so-called increased prosperity appears to have left Liverpool behind, because the level of unemployment on Merseyside at the moment is running at 7 per cent., which means that male unemployment is even higher? Precisely what do the Government intend to do to help an area like Merseyside? Are they prepared to make it a special development area to help it to overcome its serious problems?

Hon. Members: Stop striking.

Mr. Smith: The hon. Gentleman knows that the question of development area status is not for me, but I take note of what he said. We have never disguised the fact that there are particular black spots where unemployment is high. The overall picture for the regions—this is one of the guides by which we have to judge the situation—is extremely good. I mention this because it includes the hon. Gentleman's area. For the first time in three years there are more vacancies than unemployed boys and girls in every region of the country. Progress is being made overall. Unemployment is coming down and attention is being given to the difficult black spots which admittedly exist in certain areas.

Mr. John Page: Does my hon. Friend agree that the published figures of notified unfilled vacancies are probably far lower than the actual numbers? Will he

consider carrying out a small piece of research in different regions to investigate the genuineness of the figures which are presented?

Mr. Smith: I will certainly consider that suggestion. We are always anxious to do anything we can to improve the accuracy of the information that we provide. My hon. Friend is right. I am referring only to notified vacancies to employment exchanges throughout the country. We all know that there are many other jobs which, alas, are not notified to us but are available for unemployed people.

Mr. Prentice: Is the hon. Gentleman aware that the kind of smug statements that we have been hearing from the Conservative benches on this serious social problem do not reflect any credit on them at all? Is not the position that, whereas there is a welcome improvement compared with the appalling totals of 12 or 18 months ago, the figure of over 620,000 unemployed is higher than at any time in the 25 years from the end of the war until 1970? This is a disgraceful position. The figure is still intolerably high and requires a totally new policy from the Government.

Mr. Smith: There is no smugness and no complacency on these benches concerning unemployment. However, we are entitled to ask for credit for what we have done during the past three years to help to cure a difficult unemployment situation which was growing very strongly during the time of the Labour Government. The figures are still coming down. They have come down dramatically this year and are beginning to compare favourably with the position in the early part of 1970.

Following are the figures:—

RATIO OF PEOPLE UNEMPLOYED TO UNFILLED VACANCIES



May 1973 (provisional)
May 1972


South East
0·7:1
1·9:1


East Anglia
0·9:1
3·1:1


South West
1·1:1
2·9:1


West Midlands
1·5:1
6·9:1


East Midlands
1·2:1
3·7:1


Yorkshire and Humberside
1·9:1
6·0:1


North West
3·2:1
9·3:1


North
3·5:1
10·2:1


Wales
2·8:1
6·6:1


Scotland
4·1:1
13·9:1

The statistics relate only to notified vacancies remaining unfilled and do not measure the total unsatisfied demand for labour.

Employment Transfer Scheme

Mr. Spence: asked the Secretary of State for Employment how many grants have been paid to workers in development and intermediate areas in each region under the Employment Transfer Scheme.

Mr. Selwyn Gummer: asked the Secretary of State for Employment how many grants have been made under the Employment Transfer Scheme to the latest available date.

Mr. Chichester-Clark: The Employment Transfer Scheme was introduced on 5th April 1972 and by 31st March 1973 18,557 people had been paid grants under the scheme. Of these, 14,954 movements originated in assisted areas—5,511 in Scotland, 3,001 in Northern Region, 2,706 in North Western Region, 1,490 in Yorkshire and Humberside Region, 1,365 in Wales, 659 in South Western Region and 222 in Midlands Region.

Mr. Spence: Is my hon. Friend satisfied that the scheme is doing what it was intended to do? Will he give further consideration to publicity for the scheme in view of the valuable alleviation of hardship which can flow from it?

Mr. Chichester-Clark: I will certainly consider whether publicity could and should be given to the scheme itself. As for whether it is having the intended effect, I would only say that when we improved the scheme last year we hoped to double the number of Government-assisted transfers to around 16,000 in the first year. As it happens, the number of people helped has exceeded our expectations by the considerable figure I gave.

Mr. Gummer: Will my hon. Friend give particularly careful attention to the position of younger workers, especially those just leaving school, who need help to move to an area with a wider range of possibilities, since in their own areas there may be vacancies in toto but not a very wide range of possibilities? Would not help with supervised hostels and the rest assist considerably here?

Mr. Chichester-Clark: I take my hon. Friend's first point. As for help with supervised hostels and so on, one has to

strike a balance between care and over-paternalism. It is true that the Department of the Environment has powers under the Housing Finance Act 1972 to pay grants to housing authorities and housing associations towards the cost of providing hostels of approved standards. That should be a help in what my hon. Friend has in mind.

Industrial Relations Handbook

Mr. Moyle: asked the Secretary of State for Employment whether he will publish a new edition of the Industrial Relations Handbook.

Mr. Chichester-Clark: I am considering whether a new edition should be undertaken.

Mr. Moyle: Is it not a dismal commentary on the state of industrial relations under the present Government that, whereas 10 years ago there was sufficient consensus for his Department to produce a non-controversial book on how to solve our industrial relations problems, since the passage of the Industrial Relations Act that has proved pretty well impossible.

Mr. Chichester-Clark: It is no commentary of that kind whatever. The present book is of historical interest and contains a summary of the Fair Wages Act. [Laughter.] If it is of historical interest, a fact which seems to cause some mirth among Labour Members, and if there is to be a revision, perhaps we should consider including in that revision a short chapter on the rather fugitive and short-lived history of "In Place of Strife".

Mr. John Page: Will my hon. Friend seriously consider publishing again the Code of Industrial Relations Practice, possibly in a shortened form, and making it free? This is something that should have much wider circulation than it has at present, and at 15p it is rather expensive although it is well worth it.

Mr. Chichester-Clark: I do not know about 15p, but, of course, the guide to the Industrial Relations Act is free. The Code of Industrial Relations Practice is freely available. We can consider the possibility of producing a shortened version, if that is possible.

Disabled Persons (Quota Scheme)

Mr. R. C. Mitchell: asked the Secretary of State for Employment if he will make a statement on the quota scheme for the employment of disabled people, arising from the consultative document published by his Department.

Mr. Parkinson: asked the Secretary of State for Employment when he anticipates that he will announce a decision on the future of the quota system for disabled persons.

Mr. Maurice Macmillan: My hon. Friend the Under-Secretary of State for Employment made a statement about the consultative document on the quota scheme in answer to a Question on 22nd May.—[Vol. 857, c. 39–40.] This explained the purpose of the document and made clear that I shall not make up my mind about the future of the quota scheme until I have had the opportunity to consider the views of my National Advisory Council on the Employment of the Disabled and the many other organisations and individuals concerned. I hope that the Government will be in a position to take a decision on this—within the wider context of my Department's review of all its policies and services for disabled people—in the course of 1974.

Mr. Mitchell: Is the Secretary of State aware that the consultative document contains some very controversial matter, particularly the implied suggestion that the quota scheme might be abolished? While he is making up his mind what action to take, will he take steps to ensure that the present law is enforced and that employers take their quotas under the existing scheme?

Mr. Macmillan: I am well aware that the proposals in the consultative document are controversial, and the document makes it plain that there are disadvantages in all the proposals put forward. This indeed is why we are having this degree of consultation on it, including consultation with the National Advisory Council on the Employment of the Disabled. As to what can be done meanwhile, there are some firms which could well be in breach of the law since they have not received permits to engage

people other than disabled and are presumably engaging them.
The difficulty is twofold. First, there are not enough disabled people to go around, in the sense that if all firms were to take their theoretical quota they would be employing more disabled people than there are. Second, there is a considerable number of disabled people in employment who are not registered. I should not like to take action which would lead firms which are employing disabled people to press those people to register when they do not wish to.

Mr. Redmond: Does not the best form of help for disabled people lie in retraining? Is my right hon. Friend satisfied that the Government are doing enough in retraining the disabled and others as well?

Mr. Macmillan: My hon. Friend will know that we are producing a further paper, first of all on sheltered employment and second on industrial rehabilitation and vocational training, which we hope to put to the National Advisory Council early in 1974.

Mr. Harold Walker: The Government have been persistent in their demand that people in industry must obey the law. The right hon. Gentleman has been told today that there are 9,000 firms in breach of the law since, without permission from his Department, they are not operating the quota scheme. Will he now give us a straight answer as to what he and his Department will do about these 9,000 law-breakers?

Mr. Macmillan: The hon. Member says that they are law-breakers, but that is a presumption and not a fact. There are 9,000 firms that do not have permits from my Department to employ people other than those who are registered——

Mr. Prentice: Then they are breaking the law.

Mr. Macmillan: Not necessarily; they may not have taken on people.
This Government, in common with their predecessors, have taken and continue to take the view that the right way to try to help the disabled is by a range of policies to encourage their training and employment. It is not always possible to ensure that disabled people can


get the employment they need, because it is not available in the areas in which they live.

Mr. Mitchell: In view of the totally unsatisfactory nature of that reply, I beg to give notice that I shall raise the matter on the Adjournment at the earliest opportunity.

Oral Answers to Questions — POPULATION

Mrs. Renée Short: asked the Prime Minister if he will appoint an expert on population matters to the Central Policy Review Staff.

The Prime Minister (Mr. Edward Heath): It is not my intention to appoint to the Central Policy Review Staff members with responsibility for specified subjects; but Mr. C. R. Ross, who was Chairman of the Population Panel which recently reported, is a member of the staff.

Mrs. Short: Can the right hon. Gentleman cast his mind back to the Royal Commission on Medical Education, which sat from 1965 to 1968 and recommended that all medical students should have birth control training as part of their medical education? Is he aware that his right hon. Friends the Secretary of State for Education and Science and the Secretary of State for Social Services have no idea how those recommendations have been carried out or which medical schools provide this kind of training? It seems that there is urgent need for his Mr. Ross to take this matter on board and consider it urgently to see that the situation is improved.

The Prime Minister: I would differ from the hon. Lady on her opinion that this is a matter which should be handled by Mr. Ross or by the CPRS. But, of course, I am prepared to consider this matter and discuss with my right hon. Friends how this information could be obtained for the hon. Lady.

Sir D. Renton: Is my right hon. Friend aware that the Population Panel, in its interesting recent report, recommended that special responsibility for population matters should be given to a senior, non-departmental Minister? Will he take that one on board?

The Prime Minister: I was well aware of that recommendation. This is a matter that requires careful consideration, but it also depends on certain other recommendations of the Population Panel and the Government's attitude towards them. As the House knows, the Government are now considering this report carefully. I would add the proviso that, under the present governmental structure, I doubt whether it is right that there should be one specific Minister solely in charge of this matter. But my right hon. and learned Friend is right; this was a recommendation, and it is being considered with the others.

Oral Answers to Questions — INVESTMENT

Mr. Carter: asked the Prime Minister if he will now appoint to the Central Policy Review Staff a member with special responsibility for investment.

The Prime Minister: I refer the hon. Gentleman to the reply which I have just given to the hon. Lady the Member for Wolverhampton, North-East (Mrs. Renée Short).

Mr. Carter: As far as my Question is concerned, is not the Prime Minister aware that that is a very complacent statement, particularly when one bears in mind what he has been saying on the subject of investment over the past few days? Would he not agree that, unless there is a dramatic improvement in investment in the course of the next few months, the current high growth rate will prove to have been a very short-lived affair?

The Prime Minister: There was nothing complacent about my reply. What I said was that I do not propose to appoint to the CPRS members with specific commitments of the kind for which the hon. Gentleman is asking.
On the general point about investment, both the DTI investment intentions and the recent CBI survey, I am glad to say, now show a welcome increase in investment.

Mr. McCrindle: Is it not clear that industrial investment is now, albeit somewhat belatedly, proceeding apace? Does not my right hon. Friend agree that the only remaining barrier to an increase in


industrial investment is the plans for future public ownership published by the Labour Party?

The Prime Minister: Yes, Sir. My hon. Friend is quite right. All the indications now are that investment is increasing rapidly, and will do so through 1973 and 1974. I have never hesitated to make plain my view that the increase in investment ought to have come long ago, but that does not alter the fact that it is now very welcome when it is coming.

Mr. Healey: Does not the DTI survey show that, even if the prognostication is fulfilled, investment this year will still be 13 per cent. below the level of 1970? As the Prime Minister has publicly admitted to the Institute of Directors that the lavish inducements showered on business in order to persuade it to invest have totally failed in their purpose, will he now instruct the Chancellor to withdraw these inducements as they involve tax give-aways to those who are already wealthy, which is profoundly offensive to the working people whose consent the right hon. Gentleman is now seeking for phase 3 of his prices and incomes policy?

The Prime Minister: Exactly the reverse is the case. If the right hon. Gentleman had been in contact with the union leaders in these discussions, he would know that there was nothing which they wanted more or would welcome more than a great increase in investment. It is the trade union leaders who have pressed us to give the inducements to the regions which are now producing the investment.

Oral Answers to Questions — OFFICIAL DEPUTATIONS

Mr Ashley: asked the Prime Minister how many official deputations he has received since he took office.

The Prime Minister: I have met many deputations and others have presented petitions at 10 Downing Street to which I have sent replies. A precise figure is not readily available.

Mr. Ashley: Will the Prime Minister consider receiving a deputation from Members seeking a Government guarantee that the Lonrho scandal is not being repeated in other boardrooms up and down the country? Is he taking energetic

steps to discover how many other firms are indulging in these unpleasant and unacceptable practices, or does he propose to skate over the tip of the iceberg which has just been revealed?

The Prime Minister: There is no need for such a deputation. My right hon. Friends the Secretary of State for Trade and Industry and the Minister for Trade and Consumer Affairs immediately set up an inquiry into this situation under their powers and, as such, I do not wish further to comment upon it. It is now up to the inquiry to make its investigation, which can be a full one, of all aspects affecting this company. Moreover, the Government have already announced their intention of reforming company law in the next Session of Parliament and will naturally take into account recommendations which have been made in past inquiries of this kind.

Mr. Joel Barnett: Which aspect of Lonrho did the right hon. Gentleman consider unpleasant and unacceptable?

The Prime Minister: I have just said that the matter is now subject to inquiry by the Board of Trade. I do not propose to comment further.

Mr. Harold Wilson: Will the right hon. Gentleman receive a deputation about unoccupied premises in London? Is he aware that, before the local government elections, the former Secretary of State for the Environment was breathing fire and slaughter about Centre Point and the action he would be taking? Is the right hon. Gentleman aware that the present Minister yesterday decided to take no action at all? What will the right hon. Gentleman do about it?

The Prime Minister: The right hon. Gentleman is not correct in saying that my right hon. and learned Friend decided to take no action. Action of a financial kind will be taken in this case.

Oral Answers to Questions — CONGRESS OF EUROPE (PRIME MINISTER'S SPEECH)

Mr. Meacher: asked the Prime Minister if he will place in the Library a copy of his speech to the Congress of Europe 1973 at Guildhall on 13th May on economic and social policies.

Mr. Ashton: asked the Prime Minister whether he will place in the Library a copy of his public speech about Europe at Guildhall on 13th May.

Mr. Skinner: asked the Prime Minister if he will place in the Library a copy of his public speech made at Guildhall, London, on 13th May on the Common Market.

Mr. Norman Lamont: asked the Prime Minister whether he will place in the Library a copy of his public speech in Guildhall on European affairs on 13th May.

Mr. Dalyell: asked the Prime Minister if he will place in the Library a copy of his public speech to the European Movement at Guildhall on Sunday 13th May.

Mr. Adley: asked the Prime Minister if he will place in the Library a copy of his speech at Guildhall in London on Sunday 13th May on Europe.

Mr. Molloy: asked the Prime Minister if he will place in the Library a copy of his public speech on Sunday 13th May at Guildhall on the EEC.

The Prime Minister: I did so on 14th May, Sir.

Mr. Meacher: As the Prime Minister discussed the EEC regional fund, does he not agree that funds of at least £500 million will be required if Britain is to avoid reduced regional aid? What are his chances of obtaining this without major concessions on the CAP, although British food prices are already 18 per cent. higher than they were a year ago?

The Prime Minister: The Commission has put forward basic proposals concerning regional policy and these are now being discussed with individual member States of the Community. They have already been discussed at one meeting of the Council of Ministers and will be dealt with later. I do not propose to put speculative figures on the amount of the regional fund.

Mr. Lamont: Does my right hon. Friend recall that the Congress of Europe sent a telegram to the Greek Government about the imprisonment of Mr.

John Pesmazoglou? Does he not agree that, while the internal affairs of other countries may usually be their own concern, in a situation where an ex-Prime Minister has talked of impending bloodshed in that country and where the Greek Government have repeatedly dishonoured pledges to hold free elections, this must be a matter of concern for both NATO and the EEC?

The Prime Minister: I agree that these are matters of concern. It is a question whether NATO or the Community as such, with which Greece is associated, can take any effective action in this matter. At present I do not know of any action which either NATO or the Community as such could take.

Mr. Ashton: But in that speech the Prime Minister used the phrase:
It is not the pursuit of national advantage which is the basis of our policy.
It appears to many hon. Members, on both sides of the House, that the right hon. Gentleman now cares more about the Common Market than he does about this Parliament. Will he reassure us about this, or shall we see him for ever pushing the policies of the Common Market before those of this house?

The Prime Minister: The hon. Gentleman is quite wrong. What I explained was that we are interested in the welfare of the Community as a whole as well as in our own national advantage, and this surely is the correct attitude for all members of the Community.

Mr. Adley: Does my right hon. Friend agree that far from denying ourselves our own sovereignty we are, by joining Europe, taking similar steps to those which motivated people to join trade unions, the motivation being that there is strength in unity?

The Prime Minister: Yes, Sir. We are sharing sovereignty with other members of the Community and we have influence over the other members because we have jointly pooled our sovereignty in order to reach common solutions to common problems. In this respect we are no different from other organisations in which we pool sovereignty. In the United Nations, when the Security Council passes mandatory sanctions, they are binding on this Parliament whatever


it may care to say or do, and they are binding on sucessive Governments, as we are in that position following the action of our predecessors.

Mr. Skinner: On the question of the Common Market, is the Prime Minister aware that we all understand the dilemma that he is facing at present? Before he makes such statements as he did at Guildhall, such as seeing a vision of a European Union before the end of the decade, would it not be a better idea to have a word with his right hon. Friend the Member for Wolverhampton, South-West (Mr. Powell)? He could even ask him to write.

The Prime Minister: I assure the hon. Gentleman that there is no dilemma for me; but there may be one for his right hon. Friend.

Mr. Dalyell: lf, however, to borrow the Prime Minister's phrase, he is so happy with the situation that we should have an all-embracing relationship with our European partners, why is it that we have had so little influence with the Government of France in the matter of nuclear tests? [Interruption.]

An Hon. Member: This is not a laughing matter.

The Prime Minister: No, it is not a laughing matter, although I saw one hon. Member of the Opposition laughing.
I have repeatedly explained our position concerning nuclear tests by the French Government. It is exactly the same position as that of the previous administration: that we should prefer them to have joined the partial test ban treaty and not to be carrying out tests in the air. That is our position, which is perfectly understood. As regards the Community and our influence there, if the hon. Gentleman were to discuss these matters with the Heads of Government in the Community he would see how great British influence has been in the five months since we have been a member.

Mr. Molloy: During his speech the Prime Minister said that the Community did not exist for bureaucrats and economists. This was probably because the Prime Minister could see that the Community really exists for bureaucrats

and economists. Ought he not to have seen this before he rushed in to sign the treaty? Even if there are advances on the material plane, the British people will not allow their democratic procedures to be sacrificed to a bureaucratic dominance that now exists in the European Economic Community. Will the Prime Minister make that quite clear? If things are not going to change, and if he has slipped up in taking us in, he should have the courage to take us out. If not, will he move over and allow us to do so?

The Prime Minister: The Communities were created to bring greater peace and prosperity to the peoples of Europe; that was their original purpose. That is the purpose we are determined to maintain. I said that in Guildhall in as simple words as I could.

Mr. Thorpe: As the speech of 13th May which the Prime Minister made on the issue of Europe has been placed in the Library, will the Prime Minister, to get the balance, place in the Library the other speeches made on 29th July 1969 by the then Prime Minister, the then Leader of the Opposition and the present Leader of the Liberal Party? Is the Prime Minister aware that modesty compels me to say that they were all equally brilliant in their total dedication to the European cause and that any waverer on that subject, particularly on the Labour benches, would have been totally converted had he been present on that occasion? Even though we believe in a free society, it should at least be suggested that those speeches be mandatory reading for hon. Members on both sides.

The Prime Minister: I well remember the evening to which the right hon. Gentleman refers—and what a united happy band of brothers we were.

Mr. Harold Wilson: Does the right hon. Gentleman recall not only the warnings I gave about the terms of entry but that some well-chosen words of his on that occasion were used in a Daily Express front page story next day saying
Heath hedging on the Common Market

The Prime Minister: Not for the first time, the Daily Express was wrong.

ILLEGAL IMMIGRANTS

Mr. Clinton Davis: (by private Notice)asked Secretary of state for the Home Department if he will make a statement on the policy of Her Majesty's Government consequent upon the decision of the House of Lords in D.P.P. v. Azam and others on 11th June 1973.

The Secretary of State for the Home Department (Mr. Robert Carr): The House of Lords decision yesterday has confirmed what we believed the law to be and what we intended it to be.
The provisions which we wrote into the Immigration Act 1971 fulfilled our undertaking to ensure that all those settled here on or before 1st January of this year should have all their existing rights protected; but we did not, and did not mean to, give this protection to those who had come here before that date illegally and who were therefore not settled here as defined in the Act.
The power of removal under the 1971 Act applies mainly to those immigrants who come, or who have come, here without authorisation since 9th March 1968. But it also applies to any immigrants who may have entered prior to that date in defiance of a specific refusal.
I want to set out what our policy will be in using this power.
The cases of the three men who were the subject of the House of Lords decision yesterday will now be considered, and any representations made on their behalf before the end of June will be taken into account. The same will apply to the other 33 cases now awaiting decision.
In deciding these and any future cases we shall look at each one individually on its merits and compassionate grounds will be taken into account. At the same time I must make it clear that where someone is found to be in this country illegally it must be normal practice to send him away. To do otherwise would be unfair to those who have already entered legally or are awaiting to do so.

Mr. Davis: While not condoning illegal immigration, may I ask the Secretary of State whether he does not think that it is desirable that, where substantive

rights have been taken from people. Parliament should be absolutely specific about that? Will the right hon. Gentleman therefore particularise where during the passage of the Immigration Act there was any substantial debate, or for that matter any debate, on the retroactive nature of these proposals?
Secondly, has the right hon. Gentleman taken into account the strenuous criticisms of Lord Salmon concerning the Act, which the learned Law Lord described as a labyrinth of verbiage, particularly as regards the retroactive nature of the provisions?
If the right hon. Gentleman is not prepared to grant an amnesty to certain illegal immigrants, will he give an undertaking to the House that he will exercise his discretion with great generosity where people have settled down and led useful lives in gainful employment?
Finally, does not the Secretary of State consider that it is extremely unsatisfactory that those who have been open with the Home Office and with the police about having entered this country illegally should be penalised primarily for that while others who have been furtive have had an advantage conferred upon them by reason of this judgment? Does not the right hon. Gentleman think there is now a premium upon blackmail?

Mr. Can: No, I do not accept the last part of the hon. Gentleman's question. I regard my primary duty as being towards those who either were born in this country or who have come to this country legally. I believe that that is our foremost duty. I think that liberal-minded men and women who think about this question carefully and think about our remaining duty to those who still have a right to come to this country legally would support that view.
Of course I have taken note of what Lord Salmon said, but equally the decision of the House of Lords was absolutely clear. As the House will know, I was not in charge of the debates on the Immigration Bill, but I have read the Act and I am in no doubt that it is clear on this subject. At any rate, we thought that it was clear. It has now been decided in the courts, which is the proper traditional method of doing so. As I said at the beginning of my Answer, the


House of Lords decision has confirmed what we believed the law to be and what we intended it to be. There were lengthy debates on the Bill on the Floor of the House and in Committee and there was ample opportunity for raising this point and contesting it at the time.
In dealing with individual cases, all circumstances will certainly be taken into account—a man's age; the length of time he has been in the United Kingdom; the strength of his connections, if any, with this country; his personal history including character, conduct, employment record and the like; his domestic circumstances; his medical condition; any other compassionate circumstances, and any representations received. I will give all these special factors close attention.
I repeat that I think that it must be our normal practice that people who have come here illegally, knowingly committing a criminal offence to get here, should be expected to go.

Sir D. Renton: In deciding such cases, will my right hon. Friend also bear in mind that many illegal immigrants were deceived into coming here or forced to come here against their will and that such illegal immigrants would welcome the opportunity of returning to their homelands at public expense?

Mr. Carr: Each of these cases must be looked at. It is very difficult for any of us to judge what pressures were put on people to come here, but I can certainly assure my right hon. and learned Friend that any evidence that is put before us by anybody who falls in this category that he was put under pressure to come here will certainly be a factor of which I shall take great care and careful note.

Mr. Alexander W. Lyon: If this policy were intended by the Government, why did the Government never at any stage in their pre-legislation documents, in the Explanatory Memorandum, during the Second Reading speech by the right hon. Member for Barnet (Mr. Maudling), in any of the discussions in this House or in the other place make plain that they intended retrospective legislation to take away from people—said to number several thousand—immunity which had been conferred upon them by the law at that stage to stay in this country, an

immunity which is described by Lord Salmon in his judgment as a "legal status to remain"? This House is notoriously sensitive to retrospective legislation but never at any stage did the Government explain that this tortuous Bill was designed to take away that legal right retrospectively.

Mr. Carr: I must make clear that we have not in the 1971 Act altered the status of these people. When they entered this country they did so in defiance of the law, in breach of our criminal law as it stood at the time. Their status therefore has not been altered. I cannot know what was in the mind of my right hon. Friend the Member for Barnet but I would guess—and I think it is a fairly reasonable guess—that he thought, as I thought, that our intention was clear in the words of the Act. Hon. Members had the most ample opportunity on debates on the Bill, if they felt there was doubt, to raise the matter. We did not believe that there was any doubt about it, and the House of Lords has confirmed our view.

Sir F. Bennett: Will my right hon. Friend the Home Secretary accept from one who was a member of the Standing Committee and who sat through many hours of the day and the night on it that his interpretation of the sense of the Act is precisely what was intended during the Committee stage? Will my right hon. Friend accept that if there had been any element of retroactivity it would have been involved only had we conferred advantages retrospectively on those who did not possess them at the time and to the detriment of those who had the legal right to come to this country?

Mr. Carr: Of course I accept what my hon. Friend said. Whatever view we take of this issue, it would have been a different matter had we been changing by this Act the status of, and making illegal something that was legal for, these people when they came in. Had we done that without drawing special attention to it we should have been open to severe criticism, but we have not changed that status.

Mrs. Shirley Williams: Parliament is necessarily the protector of its citizens, whatever the colour of their skin—[HON. MEMBERS: "They are not our citizens."]


—the protector of all its citizens—[HON. MEMBERS: "They are not."] Parliament is the protector of the interests of its citizens and it must be the protector of the interests of the citizens of the Commonwealth of which it is the head. During the course of debate on the Bill, which was described by Lord Wilberforce, in giving the majority judgment in the House of Lords, as
A labyrinth of complicated provisions.
—and that was his phrase, not mine—there was no attempt at any stage—and we have examined the report of the entire Committee stage—to draw any attention to the consequences for some thousands of people of the provisions of the Bill in this respect.
I merely ask the Home Secretary for his assurance that in this particularly difficult matter, while he is Home Secretary, there will be the sense of responsibility which goes with drawing to the attention of Parliament any Act which may have consequences so severe for many thousands of people, which was not done on this occasion. In the decision that he makes about these individuals, will he at least bear in mind some cases, including one which came before the House of Lords in which an individual was approached by the police before the Act became law on 1st January 1973 and was precisely told that there would be no prosecution? This has led to a great deal of misunderstanding and fear in the immigrant communities.

Mr. Carr: I hope that I have already made clear that I shall take all factors and any representations that may be made into account in deciding this and any other cases that come before me. It is a complicated Act, but a great many Acts that come before the House are complicated. I cannot accept the suggestion that my right hon. Friend the Member for Barnet—and the House knows him and his approach to these matters well enough to accept this from me—deliberately withheld from the House our intentions. We believe that these intentions were clear. [HON. MEMBERS: "They were not."] We believe that they were, and at least one member of the Committee has testified that he thought they were clear. I can assure the House that my right hon. Friend the Member for Barnet believed them to be clear and

that what he was proposing did not make illegal what was legal before.

Sir D. Walker-Smith: Will my right hon. Friend expressly repudiate the reference of the hon. Member for Hackney, Central (Mr. Clinton Davis), and what was implicit also in the question of the the hon. Member for Hitchin (Mrs. Shirley Williams), as to substantive rights in that there can be no acquisition of legal rights by prescription from an illegal basis? Will my right hon. Friend further add to his impressive catalogue of the unfairness that would result the unfairness to those Commonwealth citizens who sought entry by legal means but were not able to achieve it? Would it not be severely prejudicial to race relations generally if it were thought that those who had acted illegally were better placed than those who had abided by the law?

Mr. Carr: I agree most strongly with my right hon. and learned Friend. We have a duty to those who are here legally and to those who are waiting to come and who have a legal right to come. That is our overriding duty, and we fail in that duty if we give preference to those who have come here knowingly illegally. Those who came here by definition illegally cannot in my view acquire the sort of rights about which some hon. Members have spoken.

Mr. Grimond: The Home Secretary has always held a fairly wide discretion in certain cases. Will he agree that this appears to be a considerable extension of his interpretation of how the law of this country should be administered? Therefore, has Parliament not an interest in knowing as much as possible about how this is to be done? Will he give some indication of the numbers involved? While the right hon. Gentleman has given some criteria upon which discretion will be exercised, will he say whether those involved will be entitled to be represented, whether a tribunal will be set up to consider their cases and whether there will be a report to Parliament? Will he bear in mind that the circumstances in which these people were compelled to leave their countries may be a relevant factor in their cases?

Mr. Carr: I accept the right hon. Gentleman's last point that this could


be a relevant factor and I think that I have already indicated that in an earlier reply. There is no right of appeal to a tribunal in these matters, as I understand it. We shall go on considering these cases of illegal entry as we have hitherto. All cases of people who came here before 1st January and who fall or appear to fall under this power to remove them will be considered by Ministers, who can be questioned not only on general but on particular cases in this House.

Mr. Wiikinson: Will my right hon. Friend issue an instruction to chief constables to use the full forces of the law to crack down on those blackmailers and extortionists who have procured illegal entry for unfortunate and ill-informed people who have over the past five years found themselves in such difficulties? The manipulation of those people has been one of the most unfortunate manifestations of the whole activity.

Mr. Carr: I cannot give chief constables instructions on this or any other matter, but I can assure the House that any information that comes to light about blackmail will be pursued with the greatest vigour. It is an evil trade that is going on, and anything that we can do to root it out should be done.
I apologise for forgetting to answer the question on numbers from the right hon. Member for Orkney and Shetland (Mr. Grimond), in which I know the House will be interested. I have no estimate of numbers, but I know of 36 cases. I want to make it quite clear that I am not taking any new dramatic steps to hunt out people. There is no question of a witch hunt. I must act on information that I receive in the normal way and continue efforts that we make to reduce illegal immigration. But I am not taking any new dramatic steps. There is certainly no witch hunt.

Mr. Atkinson: Because of the complications of the retrospective aspects of the matter, will the Home Secretary sympathetically consider granting an amnesty to those immigrants who have married in this country, particularly those married to British girls, raising a young family? I understand that many hundreds of them have been deported, leaving the future of

a young family to the mercies of a State grant, national assistance and so on. Will the right hon. Gentleman consider helping such families to overcome their difficulties by granting an amnesty to those men who have a good employment record, bearing in mind that employers have never been approached about the illegality of issuing insurance cards and so on to them? Where they have successfully worked over years and paid tax and so on, will the right hon. Gentleman consider the situation sympathetically and stop the dreadful suffering that is being endured by many British girls and young families in this country?

Mr. Carr: I do not think that it would be right to grant any general amnesty, however defined, when we are threatened as we are by the evasion of immigration controls on a serious and, I am sorry to say, ever-increasingly serious scale. It is right to look at each case individually on its merits. As I have already told the House, family circumstances such as those envisaged by the hon. Gentleman will certainly be among those carefully taken into consideration in each case.

NORTHERN IRELAND

Mr. McMaster: (by Private Notice)asked the Secretary of State for Northern Ireland if he will make a statement on the disturbances in East and West Belfast in the past two days.

The Minister of State for Northern Ireland (Mr. William van Straubenzee): On Sunday 10th June Protestant gunmen in East Belfast fired 50 rounds at the security forces; the driver of a bus was killed when an Army post came under fire. Seventeen rounds were returned by the security forces, in the course of which a gunman was hit and his weapon, an Armalite rifle, was recovered. Another gunman was also believed injured. Following this, a number of houses were searched, including the Headquarters of the Ulster Defence Association. Four weapons, a home-made mortar and over 500 rounds of ammunition were found. A number of arrests were made.
Yesterday the violence was mainly in the Protestant areas of West Belfast, where automatic fire was directed at troops and police. This followed an


afternoon of protests in the Shankill area against the arrest of members of the Ulster Defence Association. The security forces returned fire on seven occasions, and it is believed that four gunmen were hit.
There has been other violence in Belfast during this period, including incidents on Sunday, when four Catholic schoolboys were injured in the Antrim Road by automatic fire from a passing car and a Catholic was fatally shot in the Ballysillan area.
I am sure that the whole House will wish me to condemn these outrages utterly, and to extend its sympathy to the innocent victims and their relatives.

Mr. McMaster: I thank my hon. Friend for that statement. I too deplore the violence of the past two days, and particularly the death of the bus driver, Samuel Rush, and extend my sympathy to his relatives and friends.
Will Her Majesty's Government do all in their power to bring this campaign of violence, murder and intimidation to an end? Is my hon. Friend aware of the great insecurity and fear felt by the ordinary citizens of Northern Ireland as a result of the IRA's continuous campaign of terror and violence over the past four years? Will the Government do all they can to root out the terrorists, to declare the IRA an illegal body and to match the IRA's propaganda campaign throughout the world? People of all religions in Northern Ireland are suffering a great feeling of insecurity as a result of the war that is being waged against them by those who wish to impose by force their Republican aims on the people of Northern Ireland.

Mr. van Straubenzee: My hon. Friend's question referred to the violence of the last two days. I answered, and I fear that I must repeat, that that violence was unquestionably from the Protestant community in Northern Ireland. What must be said quite clearly is that from the point of view of both the Government and the security forces law and order will be enforced in Northern Ireland no matter who seeks to break the law.

Mr. Merlyn Rees: Is the Minister aware that we on this side add our sympathy to the relatives of those who

have been murdered in the past few days? Is he aware that it is vital that the Assembly elections, which are an important part of the Government's political approach which has had general support in the House, should not be sabotaged by gunmen? We emphasise from this side what the Minister has said, that from whatever part of the community in Northern Ireland the violence comes—Protestant or Catholic, majority or minority—it is vital that it be dealt with. Accordingly, we on this side give our firm support to the security forces in their efforts to deal with it.
We also welcome the straight talking—perhaps this is the first time it has come from some people in the Protestant community—against those in their own community who have acted in this way. We agree with the Minister that until the gunmen are defeated the due processes of law and order and democracy will not be able to be fully followed in Northern Ireland.

Mr. van Straubenzee: I entirely agree with the hon. Gentleman that the course upon which the vast majority of people of both communities in Northern Ireland are set, that of showing that they place far greater reliance on the ballot box than on the bullet, is one of the encouraging features of the present situation, and that this is well shown by the dignified conduct of, and very ample response to, the local government elections, which passed off virtually without incident. Every proper and possible step will be taken to ensure that the Assembly elections are conducted in the same way.
Like the hon. Gentleman, I welcome all those on both sides, particularly those on the Protestant side, who have been the first in regard to this incident to condemn in the strongest terms the actions of a small and unrepresentative minority.

Mr. Biggs-Davison: In view of yesterday's Press reports that our troops, who are so courageously defending the peace against those from different quarters who disturb it, have been denied protective clothing of a kind which is considered effective and which is used by the police, can my hon. Friend give the House some reassurance on the matter?

Mr. van Straubenzee: With no discourtesy to my hon. Friend, I must reply that I am sure that he will understand that questions about the equipment of the troops are for my right hon. Friend the Minister of State for Defence. My personal observation is that the troops have very effective equipment for dealing with the situations which, I quite agree, they do with the greatest distinction.

Mr. Duffy: Is the Minister aware that last night's attack was at least the third such attack on the Army by the UDA this year? How many such concerted attacks by the UDA are to be tolerated before it is proscribed along with other organisations?

Mr. van Straubenzee: The proscription of any organisation in Northern Ireland is a matter which is constantly under review. The advantages and disadvantages of so doing are weighed up constantly. However, what needs to be said more than anything else is that it matters not whether a man, a woman or a young person in Northern Ireland is a member of a proscribed or non-proscribed organisation; they are, like everybody else, subject to the law, which will be enforced.

PARLIAMENTARY PAPERS

The Parliamentary Secretary to the Civil Service Department (Mr. Kenneth Baker): I regret to have to inform the House that due to a dispute in the Parliamentary Press it has not been possible to produce copies of HANSARD in the normal form. The dispute is over a pay claim by linotype operators. I have instructed Her Majesty's Stationery Office to continue urgent negotiations with the unions to seek a solution to the dispute. In the meantime arrangements will be made to limit inconvenience to the House. To that end available copies of HANSARD are being placed in the Library and the Whips' Office.

Mr. Evelyn King: Is my hon. Friend aware that for many decades a private printer, Luke Hansard, and thereafter his sons, printed parliamentary papers without any complaint? So effective was his work that his name became famous not only in the British Parliament but

throughout the world. Further, is my hon. Friend aware that inefficiency began to set in when HANSARD was nationalised and when the printing was taken over by the Printing Office? Will my hon. Friend begin to seek persons who will be willing to take a pride in their job like old Luke Hansard?

Mr. Baker: I am very much aware of the understandable impatience that hon. Members feel about the dislocation of the Press. I am sorry that it happens. The House may like to know that about one-quarter of the printing of parliamentary papers is done by private printers. It would be exceedingly difficult for someone to take on the printing of HANSARD.

Mr. Delargy: Is the hon. Gentleman aware that this is an industrial dispute which causes practically no inconvenience to anybody?

ILLEGAL IMMIGRANTS

Mr. Alexander W. Lyon: I beg to ask leave to move the Adjournment of the House, under Standing Order No. 9, for the purpose of discussing a specific and important matter that should have urgent consideration; namely,
The subject of illegal immigrants as affected by the recent House of Lords decision.
The other place confirmed that there are three classes of illegal immigrants into this country. Anyone who came to this country between 1962 and 1968 is immune both from prosecution and from removal. Therefore, what the right hon. Gentleman the Secretary of State for the Home Department said today about the necessity to act against illegal immigrants does not apply to them.
Secondly, there are those who are illegal immigrants who may have come since January of this year. They are clearly affected by the provisions of the 1971 Act. Everybody understood that they would be. They can be removed at any time, however long they stay.
The third class are those illegal immigrants who entered the country between 1968 and 1973. They were immune from prosecution and immune from removal if they stayed longer than six months. In fact, many hundreds of them have done so.
The House of Lords has now confirmed that this House and the other place removed in the 1971 measure such immunity retrospectively. The right hon. Gentleman suggested today that there was no change of status. That was not the view of the Law Lords. All of them accepted that these people had acquired a de facto status of irremovability. Lord Salmon said that they had acquired a legal status. That must be true. In the time that they stayed here after the period of prosecution had elapsed, they were immune from arrest and they could not be brought before the courts. If they had been brought before the courts it would have been necessary for writs of habeas corpus to be issued. In those circumstances it is impossible to distinguish between them and anyone who came here and stayed legally.
This House, by the 1971 Act, passed retrospective legislation to remove the status of irremovability from many Commonwealth citizens. As you know, Mr. Speaker, and as the House knows, the House rarely engages in retrospective legislation unless the matter is of grave importance. In this instance the House and the other place never discussed this issue at any stage. The reason is not difficult to find. Paragraph 9 of the second schedule appears to relate only to those who became illegal immigrants after the coming into force of the Act. It is only by cross-reference and a tortuous form of litigation that it can be concluded that that part of the Act refers to people who had become illegal immigrants before the coming into force of the Act.
At every stage the Government assured everyone who questioned them that anyone who was settled here would not be affected by the provisions of the Act. It is only because the Law Lords have confirmed that illegal immigrants were not settled here that the situation has arisen. Therefore, it is not surprising that Opposition and Government hon. Members did not notice the provision in the course of the discussion during the passage of the Bill. It is significant that the Government never sought any opportunity at any stage to explain the relevance of the provision. Of course, the right hon. Gentleman said today that this was never the intention of the legislation.
The matter is urgent and cannot await the normal processes of the usual channels. At least 30 people are under arrest at present and may be sent out of the country at any time at the discretion of the right hon. Gentleman. The Home Office has already removed 13 people who were arrested since 1st January 1973. They were removed before the litigation which culminated in the House of Lords.
The question arises of what is to happen to the 30 people who are under arrest and to anyone else who conies to the notice of the Home Office before there is any possibility of debate in this House. I ask you to say, Mr. Speaker, that this is what Standing Order No. 9 is all about. We should have an urgent debate immediately to try to persuade the Government that even if they have now obtained the power to remove, which I consider to have been obtained by deception, they should not as a matter of policy exercise that power. That can be done only by debate and by a vote. It cannot be done by the passage of questions such as those which have been asked at Question Time. There is no opportunity for a debate and a vote unless you, Mr. Speaker, grant this application. In the interests of the many hundreds of people who are involved, I ask you, Mr. Speaker, to grant the debate.

Mr. Speaker: I am grateful to the hon. Member for York (Mr. Alexander W. Lyon) for having given me notice that he might make this application. I listened carefully to what he so clearly said. I also listened to the interchanges in answer to the Private Notice Question. It is clear that there is great interest in the House on this matter. It is also clear that there are difficult and complicated points raised by it.
I must consider, not as a matter of sympathy with individuals but on a procedural point, whether I think an emergency debate today or tomorrow is the best way to deal with this complicated and difficult matter. I am not allowed to give reasons. But I ask the hon. Gentleman, with regard to the last point which he raised, to study carefully the answer given by the Minister when dealing with the time factor. I am afraid that I cannot accept the hon. Gentleman's application.

BALLOT FOR NOTICES OF MOTIONS FOR FRIDAY 22ND JUNE

Members successful in the Ballot were:

Mr. William Price.
Mr. Lawrence Reed.
Mr. W. E. Garrett.

BILL PRESENTED

INTERNATIONAL COCOA AGREEMENT

Mr. Joseph Godber, supported by Secretary Sir Alec Douglas-Home, Mr. John Davies, Sir Geoffrey Howe, Mr. Richard Wood, Mr. Patrick Jenkin, Mr. Anthony Stoddart, and Mrs. Peggy Fenner presented a Bill to enable effect to be given in the United Kingdom to the International Cocoa Agreement: And the same was read the First time; and ordered to be read a Second time tomorrow and to be printed [Bill 155].

SCOTTISH ESTIMATES

Ordered,
That the Estimates set out hereunder be refered to the Scottish Grand Committee:—
Class III, Vote 2, Scottish Home and Health Department.
Class III, Vote 4, Scottish Home and Health Department (Civil Defence Services).
Class III, Vote 6, Police, Scotland.
Class III, Vote 8, Prisons, Scotland.
Class III, Vote 12, Scottish Courts Administration.
Class V, Vote 2, Department of Agriculture and Fisheries for Scotland.
Class V, Vote 4, Department of Agriculture and Fisheries for Scotland (Agricultural Grants and Subsidies).

Class V, Vote 6, Department of Agriculture and Fisheries for Scotland (Agricultural Price Guarantees).
Class V, Vote 10, Fisheries (Scotland) and Herring Industry.
Class VI, Vote 2, Scottish Office.
Class VI, Vote 3, Scottish Development Department.
Class VI, Vote 12, Housing, Scotland.
Class VI, Vote 17, Roads and Transport Services, Scotland.
Class VI, Vote 22, Rate Support Grants to Local Revenues, Scotland.
Class VII, Vote 5, National Health Service etc., Scotland.
Class VII, Vote 8, National Health Service (Superannuation etc.), Scotland.
Class VII, Vote 13, Social Work, Scotland.
Class VIII, Vote 2, Scottish Education Department.
Class VIII. Vote 4, Teachers Superannuation, Scotland.
Class IX, Vote 11, Royal Scottish Museum, etc.
Class IX, Vote 12, National Galleries of Scotland.
Class IX, Vote 13, National Library of Scotland.
Class IX, Vote 14, National Museum of Antiquities of Scotland.
Class X, Vote 12, Scottish Record Office.
Class X, Vote 14, Registrar General's Office, Scotland.
Class X, Vote 15, Department of the Registers of Scotland.—[Mr. Prior.]

STATUTORY INSTRUMENTS

Motion made, and Question put forthwith pursuant to order [22nd March],
That the African Development Fund (Initial Subscription) Order 1973 be referred to a Standing Committee on Statutory Instruments.—[Mr. Prior.]

Question agreed to.

CEMETERIES (ACCESS AND MAINTENANCE) BILL

4.10 p.m.

Mr. Harry Lamborn: I beg to move,
That leave be given to bring in a Bill to provide for access to and the maintenance of cemeteries.
The need for legislation to deal with the appalling conditions in many cemeteries arises particularly in London in the older urban areas, for in these areas the tremendous growth of population in the late 18th and early 19th centuries created a situation in which church authorities were no longer able to cope with the burials and, in the absence of local authority responsibility, the private cemetery companies were established to fill the void.
The position of private cemetery companies was regularised under Section 16 of the Cemetery Clauses Act 1971. This Act placed a clear responsibility upon cemetery companies to keep cemeteries, buildings and fences in complete repair and in good order and condition. But if one takes a look at the disgraceful conditions which apply in many cemeteries, it appears that the Secretary of State has found it quite impossible under the 1847 legislation to ensure that the cemetery companies carry out their responsibilities.
In many of these private cemeteries, there has been a total disregard of relatives. Maintenance and supervision have virtually become non-existent. Cemetery companies, which have drawn profits from these cemeteries in the past, are now faced with the situation that, as burials are fewer, income has been reduced, and they refuse to spend any money in maintaining a cemetery in any kind of dignity.
I can best illustrate this shameful situation by referring to Nunhead Cemetery, in the London Borough of Southwark. This cemetery, which covers an area of some 52 acres, is far more in keeping with a jungle than with a cemetery. Hundreds of trees are growing up through graves. There is complete absence of supervision, which has led to widespread vandalism, tipping of rubbish and the forcing open of gates—although it must be said that in many cases it has been necessary for relatives to force open gates in order to obtain access to the

cemetery, which, on many occasions, has been barred to them.
My right hon. Friend the Member for Bermondsey (Mr. Mellish), my hon. and learned Friend the Member for Dulwich (Mr. S. C. Silkin) and I have received hundreds of letters from relatives distressed by the disgraceful situation which has developed. As Members of Parliament for the London Borough of Southwark, together with Southwark Council we have made repeated representations in order to get this disgraceful state of affairs remedied. It has all been to no avail.
The Commonwealth War Graves Commission, which has responsibility for 690 Commonwealth war cemeteries from the two world wars, has written to me of its concern at the state of Nunhead Cemetery and many other privately-owned cemeteries in London and the United Kingdom. The Commission refers to the vandalism which has taken place and to the fact that in 1970 a war memorial had 455 of the bronze name panels stolen and was damaged beyond repair. Its letter to me concludes,
As a result, 455 war casualties now lie uncommemorated.
This situation cannot be allowed to continue.
The Nunhead Cemetery is registered in the name of the London Cemetery Company, which also has Highgate Cemetery under its control, a large part of which carries the same appalling mark of neglect and decay. The Nunhead Cemetery is actually owned by the Raeburn Group Limited, which has acquired the cemetery for what can only be a speculative investment. It would appear that, as a deliberate matter of policy, conditions at the cemetery have been allowed to run down and are continuing to be run down in order to produce a situation in which the public in the area will be prepared to accept what the Raeburn Group calls a "socially acceptable development."
I ask the House to give leave to me to introduce this Bill in order to enable the Secretary of State, where cemetery authorities have failed to fulfil their obligations under existing legislation, to take power over a cemetery, with the assets of the company in default being vested in the local authority. There


would also be need for the Secretary of State to make special monies available in these areas to enable the local authorities to deal with the shameful neglect which has developed over so many years.
Certainly in my own area—and the same is true in many of the other older urban parts of the country—this matter is of great concern. We are not dealing with past generations. The majority of my constituents and of those of my right hon. Friend the Member for Bermondsey have their mothers and fathers buried in Nunhead Cemetery—many of them their brothers and sisters, too. I therefore ask for leave to introduce this Bill to remedy a disgraceful situation.

Question put and agreed to.

Bill ordered to be brought in by Mr. Harry Lamborn, Mr. S. C. Silkin, Mr. A. W. Stallard, Mr. Thomas Cox, Mrs. Freda Corbet, Mr. Ronald Brown, Mr. Ernest G. Perry, Mr. George Wallace and Mr. Clinton Davis.

CEMETERIES (ACCESS AND MAINTENANCE)

Bill to provide for access to and the maintenance of cemeteries, presented accordingly and read the First time; to be read a Second time upon Friday 20th July and to be printed. [Bill 156.]

NATIONAL HEALTH SERVICE REORGANISATION BILL [Lords]

As amended (in the Standing Committee), considered.

New Clause 1

OCCUPATIONAL HEALTH SCHEME

Within five years of the coming into force of this Act the Secretary of State shall lay before Parliament his proposals for providing an occupational health scheme for all industries which employ in total more than two hundred and fifty thousand persons.—[Mr. John Silkin.]

Brought up, and read the First time.

4.20 p.m.

Mr. John Silkin: I beg to move, That the clause be read a Second time.
It is 14 years, I think I am right in saying, since the Government of the day

accepted the ILO Convention and agreed to the development of occupational health services. Time has gone by, Government have succeeded Government—I make no party point of this—and every Minister of Health there ever was has always told those of us who would like to have an occupational health service established, "You are knocking at an open door". Some of us began to think that it is time not only for that door to be opened but for us to be invited inside.
The reasons for an occupational health service, I should have thought, are self-evident. We live in an age in which industry is the predominant occupation of the overwhelming majority of workers in the country. Most of their waking hours are spent in the work they do in factories and industries which they run. It is there, and there above all—in their employment—that they are most exposed to the hazards of the age in which we live. All of us are beginning for the first time to take some notice of the effects of pollution. It has an effect upon employees in addition to the effect on their work when they may be injured at work. That is an obvious hazard which they have to face. Yet all these things fade into insignificance beside the enormous stress of modern life, a stress which occurs so markedly in the work in which people are engaged.
There is not only the stress in the work in which people are engaged but even the effect on their very fitness mentally and physically to do the work they are supposed to do. All these things cause a greater degree of illness and injury in the actual occupation than happens in the home. For this reason, the idea of an occupational health service is something which has been in mind, at least as to lip-service, among most hon. Members throughout these years. What has not followed, however, is appropriate Government action to meet the point.
I have talked about injuries at work and illness, but of course there is another factor. I suppose that we are all very much aware that prevention is better than cure. It was not necessarily so recognised in the past, and people did not perhaps realise it when the National Health Service was set up, but all of us are very much aware of it now, none more than the Under-Secretary of State.


I will quote his golden words, spoken in Committee on the Bill:
Modern chemo-therapy and modern sanitation have virtually cleared up all the cruder manifestations of ill-health, and we shall make a leap forward only if we really get cracking on prevention. It is certainly the purpose of the Bill to secure that"—[OFFICIAL REPORT, Standing Committee G. 12th April 1973, c. 142.]
Those of us who favour the implementation of an occupational health service have been waiting with baited breath for the Under-Secretary to tell us when he will "get cracking". Alas, so far there has been only an ominous and prolonged silence.
We have been told under both Governments that the Employment Medical Advisory Service has been allowed to get under way and that, because of its scope of employment and health hazards, in dealing with this situation it will be sufficient—but of course it will not. I remember that the Under-Secretary said—I cannot quote the reference—that he agreed that the EMAS was only a temporary matter and a question of timing. As his predecessors, he said that we might move to an occupational health service in legislative form under the National Health Service. Of course if it is only a temporary thing, if the whole of the EMAS is to remain with the DEP for the time being, we are discussing only the question of timing.
One of the tragedies of legislation in this country is that, however well-merited legislation may be, there is always someone to tell us that now is not the right time and that it should be another time, perhaps. Then the years go by, but it is never quite the right time. I can understand how the argument developed in the past. First there has been the idea that the setting up of an occupational health service would be very costly and substantial financial resources would be devoted to it when they could be better employed in other areas of the Health Service. There have been many Cinderella parts of the Health Service, as we all agree. We have seen how the long-stay hospitals have deteriorated from bad to worse, as have the geriatric wards, mental hospitals and so on. All these certainly are deserving of care. But we have to bear in mind that prevention is not only better than cure, particularly for those who require eventual cure, but it

is also in the long run a more economic method. For that reason, occupational health services have been engendered by large companies here and there throughout the country, to their credit. It must be admitted that they have been effective.
We are proposing by this new clause to see that the Government act on the right lines, to give them time to prepare a good occupational health service. We have limited it to industries which employ 250,000 people. I would not argue about 50,000 either way, but one must make a start somewhere. I see that if one applied this to industries with a smaller number than a quarter of a million one might create difficulties, but I do not think that such difficulties would occur in industries with round about that total of workers.
Another factor is that we have given the Minister and his successors five years in which to prepare for a total occupational health service. That is a good long time. I should have thought that even if this Government went on their shambling course to the last humiliating day of their term, which I work out as two years, one month and 12 days—it may be 11 days—in that period there would certainly be time to receive the results of all the surveys the Government are making, or could make.
It cannot be said that we are exactly rushing the Government. We are saying that, after all the talk since 1959 about a comprehensive global occupational health service, let us get on with it. Five years is sufficient time. We are not hurrying the Minister or the Department or anyone. We are preparing the ground for what could be a most revolutionary step forward in the health and prevention of sickness of our people.

Mr. Timothy Raison: The right hon. Member for Deptford (Mr. John Silkin) spoke in his usual sweetly reasonable way, as he did many times in Committee on the Bill, but I wish to import a discordant note into what has been said and to try to raise the question whether even the principle of an occupational health scheme is all that it is cracked up to be.
I wish to look at the new clause in terms of three aspects. The first is whether as it stands the clause is sufficiently clear to make sense. I am


not immediately cleat about whether the clause is referring to one scheme for the whole of industry or one for each industry. That obviously is a point of detail, but I think that before one could accept the clause one would have to look hard at industries which are heavily fragmented. The Opposition have plucked the number 250,000 out of the air—and the right hon. Gentleman said that it might be 50,000 either way. I assumed that he was speaking about industries one could get one's hands on, as it were, but what about the retail industry? Does that qualify? Are we to set up an occupational health service for the retail industry covering thousands of little shops throughout the country?
The principle of an occupational health service is either right or wrong. If one believed that it was right, one would say that it should be made available for all industries, or at least all industries which could be shown to need the service, and not on the principle of an arbitrary figure.
4.30 p.m.
There is, secondly, the question of resources. I firmly believe that there are many higher priorities in medicine today than this. There is no need to produce a catalogue of priorities, but hospital waiting lists need a great deal of attention. We would agree that the disparities between the different regions in terms of medical provision is something else which needs attention. I do not believe that occupational health rates as highly as these other things.
I come to the question whether the principle of an occupational health service is the right one. I know that it has been sanctified by the ILO and I know that previous Governments have said that it is a good thing. I suspect that it is one of those things which people automatically say is a good thing without thinking hard about it. They accept the argument that people spend a great deal of their time at work and that people have illnesses connected with work or meet accidents at work. But I do not think it necessarily follows that, because of that, an occupational health service is the right answer.
There may be industries in which there are special hazards and in which some sort of occupational health service makes

sense. That is a case that can perhaps be made. If we consider an industry such as coalmining, I should be surprised if doctors operating in those areas were not fully conversant with the special problems created by coalmining.
As a general principle my objection to the occupational health service—and this is a point on which a decisive argument has not been made—is simply that it conflicts with the notion of the family-based health service, which is what I want to see. If we take the analogy of social work, we can consider the introduction of the Seebohm Report and its subsequent implementation. There was a great fragmentation of social work. The Seebohm principle was to concentrate social work on the family services, as is done to a great extent in respect of health. I do not believe that, because a person incurs an illness while at work, that illness should necessarily be treated at work. It seems preferable for it to be treated by a person's family doctor.
The truth is that if there is an occupational health service and a family service running in parallel, many people will use the occupational health service because it is rather more convenient to see the doctor or the nurse, to pick up prescriptions and so on, while at work.

Mr. John Silkin: Is the hon. Gentleman advocating—and this must be the logic of what he is saying—the abolition, for example, of appointed factory doctors?

Mr. Raison: I accept that there is some limited scope for the provision of medical health in the factory. Equally, I believe fundamentally that the goal which we should have in mind is a family-based service. The best person to treat a patient is the family doctor, who has all the knowledge, who knows the family context and who can tie up the whole of a person's medical treatment in one bag.
We all know the problems of split treatment. We know of the problem where one person is treating a patient at one moment but does not know what other treatments are taking place at another moment. That can be avoided by making it the normal thing for a person's health, and I include preventive work, routine testing or anything else, to be the responsibility of the family service. I hope that my right hon. Friend


will resist this new clause on the grounds both of expediency and of principle.

Dr. David Owen: I wish to support the new clause but from a slightly devious stance. The clause is very modest. If we believe that something is to be done five years is far too long and I would much prefer the two-year time-scale recommended in the Labour Party's policy document. The time needed for a survey is the minimum period necessary before decisions are taken. I do not agree with the remarks of the hon. Member for Aylesbury (Mr. Raison) about the delineation of these particularly large sections of industry. If it is thought that an occupational health service is necessary, it is needed overall. The way it is implemented overall is something which has to be considered industry by industry, area by area. There is a need for an overall policy which would operate within small factories, which can be some of the most dangerous places.
The nub of the question comes down to the two points raised by the hon. Gentleman, resources and a family-based service. I agree with the argument he put against it although I disagree with his conclusions. Let us deal with a family-based doctor service. I too think that this is an essential element of a national health service.
I wonder whether the hon. Gentleman has spoken to family doctors in areas where there is a group occupational health service or where there is an industry-based occupational health service. I believe he will find, with few exceptions, that general practitioners in such areas strongly welcome the occupational health services. He will also find that there is an extremely good relationship between the doctors and, more important perhaps, the doctors and the occupational nurses working in those industries.
By constant communication there is no overlap of responsibility. It is possible to retain the element of the family-based service and yet save the family doctor a great deal of time, enabling him to give a more effective and efficient service. Before the hon. Gentleman adopts this stance he should make sure that the GPs in his area agree with his criticisms. I think he will find that they do not.
The hon. Gentleman should question why practically all doctors' organisations support the introduction of an occupational health service. An organisation such as the BMA often supports all the different claims of its constituent elements without necessarily looking at overall resources. There is the problem of resources. We know that the Department of Health and Social Security in its evidence to the Robens Committee on accidents and safety which looked at occupational health services, although somewhat cursorily, said that it could not possibly have an occupational health service in under 10 years.
I hope that the Minister will produce some of the evidence on which that statement was based. We well know that Sir George Godber and the various advisers of successive Ministers of Health have opposed an occupational health service, mainly because of the resource allocation question. I do not think it is necessary to have so many doctors in an overall national occupational health service as many people believe.
By using ancillary help and occupational nurses a great deal can be done. Why is it that other countries have an occupational health service, and why is it that many of us believe this to be an urgent priority? To put the Robens Report in perspective, and its recommendations were largely concerned with accidents, of the 314 million working days lost through sickness absence in 1970–71 only about 7 per cent. can be accounted for by industrial accidents. In 1970–71 31 million working days were lost through absences due to mental health disorder, which form 10 per cent. of all sickness absences. That is 50 per cent. more than the total absences due to industrial accidents.
For every day lost by strikes 10 days were lost by industrial disease and injury, and for every day lost by strikes 100 days were lost by ordinary illness. Yet this House and successive Governments spend hours discussing how to reduce the number of strikes. We also spend a good deal of time looking at the problem of industrial accidents. Yet we spend little or no time trying to produce better health for the worker in his place of work, using the access and availability of the worker which is one of the essential ingredients of an occupational


health service. We cannot afford to go on ignoring this large, captive patient-group, which spends the vast majority of its working week at its place of work.
If we are serious about preventive medicine we need to look more seriously at occupational health. The Department of Health and Social Security must justify its stance. The Secretary of State nodded at every word the hon. Member for Aylesbury said. He clearly thinks that occupational health has a very low priority. It would be better for him to spell out exactly why he thinks it has a low priority than to pay lip service to the need for an occupational health service and do nothing about it. Not only is it desirable, but there is an overwhelming case for it to be given much higher priority.
The Robens Committee recommendations on occupational health are a considerable disappointment, but if the evidence which was given to the committee—as Mr. Robinson, the trade union member of the committee, said—was that it could not be contemplated for 10 years, it is not surprising that the committee embraced the second best, the Employment Medical Advisory Service. In the Second Reading debate on the Employment Medical Advisory Service Bill I urged the Government to consider occupational health when they were considering the reorganisation of the health service.
Medical officers of health will now come into the National Health Service, with responsibility as community physicians attached to area health boards. They are doctors with considerable experience in preventive medicine but who have not yet had experience in occupational health. They could take as one of their responsibilities occupational health, and they should be given a mandate to cover occupational health in their area.
The Employment Medical Advisory Service contains only 100 doctors, a great many of whom are tied up with inspection. Professor Wood—another member of the Robens Committee—said that occupational health was equally as important as the prevention of accidents and in future will become more important. The Secretary of State may scoff-off other people's remarks, but presume-

ably he will not scoff off the views of Professor Wood.
The Secretary of State should explain to the House why he gives such low priority to occupational health and why almost everyone who looks at occupational health comes to the conclusion that something should be done urgently. There was the Dale Committee in 1951 and the Portia Committee in 1952, and we have had successive debates in the House, yet once Governments get into power they become susceptible to the arguments used by the Department of Health and Social Security against an occupational health service. A small group of men in the higher reaches of medicine have consistently blocked any advance in occupational heath. They cannot go on blocking it in silence. They need to produce evidence and justification.
If it is said that resources are not available, perhaps the Minister will say how many doctors and specially trained nurses are needed for an occupational health service. The Labour Party policy is an evolutionary, gradualist approach, trying to highlight areas where there are deficiencies, moving in after a period of regional study and putting in an occupational service by degrees. It is not a proposal for instant money-spending which will stretch resources, but a carefully worked-out proposal after a two-year period of survey and then a phased introductory period. We are not advocating a block occupational service such as the initial introduction of the National Health Service.
Most people accept that industries with an occupational health service should be able to carry on with their existing service. We have to evolve a structure which uses area health board facilities, group occupational service schemes and industrial occupational health schemes. There should be a tripartite approach to the problem of providing a national occupational health service.
This is a major and important issue. I have consistently argued that higher priority should be given to a national occupational health service ever since the Labour Party was in Government. Two years is the minimum period that should elapse between the decision to go for an occupational health service and the implementation of that decision. I hope that it will be a shorter time.

Mr. John Silkin: There is nothing in the clause to say that it cannot be done more quickly.

Dr. Owen: If we were given the opportunity as the result of a General Election to introduce an occupational health service earlier, I hope that we should act within the period of five years by a handsome margin.
My plea to the Labour Party and to the House is to give occupational health and the ill health that affects the worker in his work place—not always as a result of his work—far higher priority and accord to it just a fraction of the time, effort, energy and resources that we give to reducing the number of strikes and accidents in industry. We shall receive a significant return for that investment.

4.45 p.m.

Mr. Christopher Mayhew: I agree profoundly with my hon. Friend the Member for Plymouth, Sutton (Dr. David Owen). I agree with his reservations about the clause. The fact that we intend to initiate an occupational health service in advance of five years is a good reason for not putting five years in the clause. I agree—and I think I am here agreeing also with the hon. Member for Aylesbury (Mr. Raison)—that, rather than improving the occupational health service in industries employing more than 250,000, it would be better to aim at an overall occupational health service, starting with the industries where it is most needed. That seems to be a more practical approach.
I wish to argue in favour of this concept because of the contribution it can make to the great and growing problem of stress at work about which my hon. Friend spoke. This is primarily not a medical problem but a management problem, and it is a problem to the solution of which an occupational health service could make a great contribution.
As I see it, the problem is the feelings of anxiety, inadequacy and frustration at work which are partly or wholly caused by bad psychological environment. Stress at work is hard to pin down and quantify. Because it is produced by so many variable factors people are encouraged to think that it is not widespread, that it does not cause great suffering, that it is not important and that nothing practical can be done about it. All those

opinions are wrong. Noise, radiation, dust and fumes can be measured and quantified, but the emotional environment cannot, certainly not yet. As a result, the size and importance of this whole problem have been neglected. It is extremely important and many practical things could be done to relieve it. This real suffering creates an unacceptable level of absence from work and sometimes leads to serious mental breakdown.
I should like to put on record a notable speech made by the Chairman of the 101st annual Trades Union Congress, Mr. John Newton, who said:
Where work gives little or no satisfaction to the worker, where there is no freedom to exercise talent or skill, where men and women do not determine how they do their work, where they have become merely components in the production system, they have during their working lives lost their identity as individuals. This they feel, and underlying many strikes is a protest against this unnatural environment.
If the society in which they live does not provide them with compensation for this loss of identity, there were social consequences as well. And until we have an occupational health service committed to a study in depth of the psychological consequences of modern production methods, unrest will continue. Indeed, in the absence of these remedies, strikes are likely to continue in the process of mental and physical re-adjustment.
Nobody who has not experienced the effects of years of confinement within the walls of mass production, without apparent means of escape, can understand the debilitating effects on the mind, the vocabulary, on the spiritual capacity of human endurance. Nobody, without this experience, can really understand why men down tools, when on the surface there seems to be only a pretext, to escape momentarily from the monotony of an unnatural existence.

Mr. Raison: I entirely accept the force of these arguments. I accept that stress and the organisation of work are extremely important matters. As the hon. Member for Woolwich, East (Mr. Mayhew) said, it is within industry, in management, that important decisions about how to remove these difficulties can be made. Would it not be far better to see this as being the clear responsibility of the Department of Employment—perhaps the Department of Trade and Industry as well—rather than putting it under the National Health Service, which will not have the same power to twist the arm of industry?

Mr. Mayhew: It is a clear responsibility not only of management but of the trade unions, and indeed of everybody concerned in industry. I am arguing that in addition the medical profession can make a contribution. I have in mind physicians who could treat people as individuals but with a knowledge of a person's working environment. Such a physician would be particularly well-placed if he had special training in this subject.
My hon. Friend the Member for Sutton drew attention to the extent of the problem. The Mind campaign has calculated absences from work through phychosis, neurosis, debility and headaches at nearly 37 million man-days in 1969–70, far more than the number of days lost through industrial disputes. This excludes things which are increasingly recognised as symptoms of stress, such as dyspepsia, skin complaints and muscular aches and pains. This is a growing problem. The total of absences through certified sickness rose 22 per cent. in the 15 years up to 1970, but the absences through neurosis and psychosis rose by 152 per cent. for men and 302 per cent. for women.
This is a fast growing problem which will require serious effort before it can be overcome. Research into it has hardly begun. I was glad to see in the recent Labour Party policy document at least one line calling for more research into the problems of stress at work. Perhaps the subject was not adequately and fully dealt with in that document, but it was at least a move forward.
The Mind campaign gave its evidence to the Robens Committee in support of an occupational health service to combat this problem, among others. It emphasised the danger of over-promotion—in other words, giving to a man a job which it is beyond his capacity to undertake—and also emphasised the danger of under-work, which can be pleasant for a time but eventually leads to loss of confidence and self-respect, tension and sometimes illness. There is also the danger of inadequate job definition when a worker has no idea whether he is responsible for certain tasks which worry him. There is also the danger of lack of effective consultation and communication which may cause people to suffer needless fears about

sudden changes in their employment, fear of redundancy and all the rest. Finally, there is the danger of financial insecurity, which is endemic in many parts of industry.
In our evidence to the Robens Committee we recommended an occupational health service covering all the working population not already provided for by industrial health schemes. The occupational health scheme would consist of physicians, nurses, welfare officers and social workers working closely with general practitioner services. They would help in the early identification of stress symptoms related to the working environment and would be able to advise the management in preventing and minimising these consequences. It was a great disappointment to all concerned with an occupational health scheme that the Robens Report entirely neglected this side of the problem. The terms of reference given to Robens include concern for health in industry, but there is no reference in the Robens Report to the subject of stress at work, nor is there any reference to the evidence given by societies, organisations and individuals concerned with this important subject.
We have in this country at present only 600 full-time occupational physicians. It is worth looking at what is happening in other countries. In Sweden every firm with more than 500 employees has at least a nurse and a personnel adviser. Every firm with more than 2,000 employees has in addition an occupational physician; every firm with more than 4,000 employees has, in addition to a personnel adviser and an occupational physician, a social worker; and every firm with over 10,000 employees has in additional a psychologist.
I wish to emphasise that this is not just a medical problem. Industrial physicians can provide an immediate service to the individual based on an understanding of the individual and of his working environment, and they can communicate expertly with individual general practitioners. Subject to the medical code, these physicians can also explain to senior management the kind of circumstances which help to produce this kind of illness.
This situation is also the responsibility of management and of trade unions, and


I am glad to see some mental health element being injected into management courses run by the British Institute of Management and also into courses for shop stewards run by the TUC. However, all this activity still falls far short of what is needed. Everybody with responsibility in industry should have education and training to cope with the challenge of stress at work, to cope with crises and breakdowns when they occur and to help with the recovery and rehabilitation of persons affected.
The subject of stress at work provides a vast field of research, but, even given our restricted knowledge of causes and cures, it also provides a vast field for practical remedial action now. The time has come for a national campaign against the evil of stress at work and the mountain of avoidable misery that it causes. We should welcome the new clause for many reasons, but particularly because it is an important first step in the right direction.

Mr. Kenneth Lomas: My hon. Friend the Member for Woolwich, East (Mr. Mayhew) always brings to these debates a knowledge of mental problems, and the right sort of emphasis was placed on this subject in his speech. I agree with my hon. Friend the Member for Plymouth, Sutton (Dr. David Owen) that this is a major subject to be considered.
The hon. Member for Aylesbury (Mr. Raison) asked whether the principle sought in the clause was the right one. In my opinion the principle has already been established and the clause seeks an extension of it. We already have the National Health Service, and we want to improve it. We already have industrial doctors and nurses operating in factories, and we want to extend their services. Therefore, the principle has already been well established.
Is the clause clear? My right hon. Friend the Member for Deptford (Mr. John Silkin) said that there was nothing to stop an incoming Government bringing in an occupational health service within the five-year period, and I hope that this will be done. I regard the figure of 250,000 persons as too high, but it is a matter which can be further studied in debate and no doubt can be resolved.
We must then turn to the subject of resources. Have we enough money to provide an occupational health scheme? It would appear that we are already spending a great deal of money on many subjects which overlap one another and are not being properly co-ordinated. If those activities were brought under one umbrella instead of being allowed to overlap, as is happening at present, we would save a good deal of money in the long term and could use it for the purposes set out in the clause.
We have been told by the Government only recently that such a scheme would conflict with the family doctor service. t believe that the opposite would happen and that the scheme would be complementary to the family doctor service and in many ways would assist it. For that reason in particular I support the idea behind the clause.
Over the past 30 or 40 years there have been calls under both Conservative and Labour Governments for an occupational health service. With a working population of over 25 million people such a service is vital in determining the standard of personal health, and any consideration which does not include an occupational health service is unrealistic. A sick mind in a sick body acts as a drag on the individual and his work. If a man is unwell he cannot do the job he is paid to do and the productivity in the labour force of which he is a part suffers.
5 p.m.
My hon. Friend the Member for Woolwich, East emphasised the increase in stress and mental illness. I wish to mention another ailment which creates as much absenteeism as, if not more than, mental illness. I refer, of course, to migraine. Recently the Under-Secretary gave the all-party group some interesting information about it.
Migraine could be treated in an occupational health service. It is responsible for a considerable amount of absenteeism, bearing in mind that roughly 10 per cent. of the population suffer from it. That means that about 2·5 million working people are off work because of it. If migraine sufferers could obtain treatment when they had attacks at work they would be helped a great deal. The


Minister has the power to set up headache and migraine clinics under the National Health Service. Unfortunately, however, London has only five and there are very few in the provinces.
An occupational health service is not a luxury but a necessity for the safety and health of people at work, and everyone in work is not only his own keeper but his brother's as well.
We often hear about the millions of days which are lost through strikes. Very many millions more days are lost because of sickness and injuries. For every penny which has been lost through strikes over the years, 99p has been lost because of illness and injuries at work.
Many people will say that we do not need an occupational health service because employees are protected by the provisions of the Factory Acts, and so on, which take care of many problems. However, there are many anomalies and many things wrong with the set-up under the Factory Acts. We have to look at them again. For example, employees in hospital staff canteens are covered, whereas those in patients' canteens are not. Hospital laundry workers are covered. Hospital boiler workers are not. Men building a bridge are covered under the Factory Acts. Men maintaining a road are not.
The functions of an occupational health service were agreed as long ago as 1950 by a joint committee of the ILO and WHO which said:
Occupational health should aim at the promotion of the highest degree of physical, mental and social wellbeing of workers in all occupations; the prevention among workers of departures from health caused by their working conditions; the protection of workers in their employment from risks resulting from factors adverse to health; the planning and maintenance of the worker in an occupational environment.
That is saying, in other words, that what is important is the adaptation of work to man and of each man to his job.
To make that effective it has to be done on a national scale under one command. This is where I go further than my right hon. Friend the Member for Deptford. We have a situation where local health authorities have their own inspectorates relating to sanitation, general environment, and so on, in factories. The

Department of Health and Social Security runs pneumonconiosis, mining, pottery, asbestos and sandstone panels. The Treasury appoints doctors to examine civil servants before they take up employment and, after illness, to assess their fitness for work. The Ministry of Defence has an industrial medical service for its factories. Then there are the Armed Services and other public bodies all with their own services. Perhaps the mining industry has the most highly developed of these services, including legal provisions, full-time medical officers and financial rewards for developing new safety methods. There is still a long way to go, however, and this is why we need to combine our resources into an occupational health service both for research purposes and to help those who deserve it most.
A large number of big enterprises already employ nurses with industrial nursing certificates, but nearly 90 per cent. of the doctors inside our factories are part-timers. We ought to have people who specialise in this work for the benefit of those in industry.
The Department of Employment has its Industrial Health Committee. The Factories Inspectorate has a number of medical inspectors and conducts certain research. I could give many more examples, but I think I have proved the need for them to work together. There is a tremendous overlap, and what we should be looking for is an occupational health service which can take the place of the old Factory Acts system and the industrial health service. We want a true occupational health service which will take care of people at work and ensure that they can do their jobs more efficiently and effectively. By that means we can enrich the lives of people in industry and increase the well being and health of the nation.

Mr. Laurie Pavitt: The powerful case made by my hon. Friend the Member for Woolwich, East (Mr. Mayhew) emphasised what is already known to the Under-Secretary, that, bearing in mind the responsibility that his Department has for all aspects of health, the most serious growth in ill health arises from stresses and the resulting mental illness, and that these are matters which need to be tackled urgently.
My hon. Friend the Member for Plymouth, Sutton (Dr. David Owen) challenged the statement by the hon. Member for Aylesbury (Mr. Raison) about the relationship with the family-based service which we believe to be the very front line of defence. In my constituency I have the Central Middlesex Industrial Health Scheme. It is an experiment where the Department of Health and Social Security provides the consultants, where the local authority provides certain services, where Messrs. Guinness provides the land and buildings and where local industrialists provide the money required to employ industrially qualified nurses.
The hon. Member for Aylesbury tried to make a difference between the family doctor and the resources used for family-based medicine and medicine based on the hospitals. He asked whether we ought not to put more resources into reducing waiting lists. If the hon. Gentleman cares to come to Central Middlesex I can provide him with statistics showing that this happens.
The industrial medical service has meant far less referral to out-patients departments. For general practitioners it solves one of their great problems. In all medicine, doctors, whether domiciliary or industrial or working in the hospital service or in local communities, seek not to treat symptoms but to find and eradicate causes. A general practitioner with 2,500 patients on his list and six minutes for each patient finds it relatively easy to get at the symptoms. It is much more difficult for him to get at the causes. Bearing in mind that more often than not those causes arise during a man's working life, clearly this is a service which general practitioners in my area welcome, as I am sure most doctors do.
This is a short debate, and all of us would like to say a great deal more than time allows. However, my right hon. Friend the Member for Deptford (Mr. John Silkin) reminded us of the lip service which is paid to the idea of an occupational health service such as that proposed by the ILO convention of 1959. Nowhere does that occur more than in this Chamber. I remember Prime Minister Macmillan 10 years ago resisting pressure which I put on him for an occupational health service in the Palace of Westminster. Today we still have only

a first aid box and the services of any available hon. Member who happens to be medically qualified. We have about 800 workers, quite apart from 600 or so Members and the Members of the House of Peers. At this time of the year some 2,000 people are in the Palace. It is true that we have an arrangement with Westminster Hospital, which gets an ambulance here quickly if it is required. However, probably no section of the community is more subject to stress than hon. Members sitting in the Chamber at the moment.
The concept of the emergency medical advisory service is already an outdated and narrow one. It does not touch even the fringe of the argument put forward by my right hon. and hon. Friends when talking about an occupational health service. Secondly, there is already a strong base from which we can work. There are 70 whole-time and 1,000 part-time medical officers in industry. The clause would make it possible to move towards a career structure and adequate training for grope qualifications in industrial medicine not only for doctors but for State-registered nurses.
We must be able to see ahead. The clause refers to five years. With a Labour Government it would be less than five years. I think that my right hon. Friend had in mind that with a Conservative Government it will probably take five years. If the clause were accepted, we could get moving now all the necessary organisation to back up what needs to be done. Indeed, as I said, we have a base from which we could start.
The Under-Secretary will know from the documentation which has been prepared by industrial medical officers over the last three years that a lot of research has been carried out. Indeed, there is more than many people realise. Post-graduate training has been going on at three university departments of occupational medicine—Newcastle, Manchester and London, the latter incorporating the TUC Centenary Institute of Occupational Health—and at three other university departments of social medicine which have a commitment to occupational medicine. The Medical Council, which I had the privilege to serve recently, has undertaken research at a number of units: the Environmental Physiology Unit, the Industrial Injuries


and Burns Unit, the Applied Psychology Unit, the Pneumoconiosis Unit, the Toxicology Unit, and the Unit on Occupational Aspects of Ageing. Therefore, the idea of starting with a blank sheet is not right. We have something. However, over the last 10 to 15 years we have neglected the opportunities open to us. This is the meaning of the clause.
The Robens Report, which the House has not yet had an opportunity to discuss, is totally inadequate. It does precisely what the Opposition have been objecting to throughout the debate. It looks at treatment and vaguely at accident prevention, not the complete health of the individual. Implementation of the Robens Report will leave untouched the present apathy. We need the clause to give a shove, an impetus, some meaning and direction.
Despite the argument about resources, it is well known that there will never be sufficient resources. But, by the intelligent use of the resources that we have, I feel certain that we could build a fourth wall to the National Health Service. At the moment it has three walls which cater for community, domiciliary and hospital medicine. The fourth wall is completely open to the elements. It needs that wall to be built. The clause will enable that to be done.

Dr. Anthony Trafford: I should like to make a brief intervention. It was disappointing to me that the right hon. Member for Deptford (Mr. John Silkin), in moving the clause, did not define what he meant by "occupational health". This has become even more apparent as other Opposition Members have spoken. The hon. Member for Woolwich, East (Mr. Mayhew) directed his remarks to one small, though not unimportant part of a total service.
There was considerable confusion in what the hon. Member for Plymouth, Sutton (Dr. David Owen) said about what appeared to be a sphere of preventive medicine, research and industrial medicine and what amounted to a sort of glorified form of first aid.
This degree of confusion in the aims and objectives of the clause is far too woolly. If we knew what the right hon. Member for Deptford and his hon.

Friends were proposing, it might be capable of what I might call sustained analysis. As it is, it seems to have comprised a series of non sequiturs from various hon. Gentlemen opposite and a considerable confusion as to what the clause means. The right hon. Gentleman does not appear to have thought out the consequences of accepting a full occupational health scheme on a national basis. My hon. Friend the Member for Aylesbury (Mr. Raison) mentioned just one, but I can think of many others.
The hon. Member for Willesden, West (Mr. Pavitt) referred to a number of units—the Industrial Injuries and Burns Unit, and so on. These cannot come under the sort of occupational health scheme about which the hon. Member for Woolwich, East was talking. They are matters of great importance, but they do not come under the same scheme. They arc not on the same wavelength. The whole concept, as expressed by the Opposition, is very woolly. For that reason, without going into the philosophical questions of the overall value of an entirely different concept and of resources, the clause is far too woolly to be either understood or accepted in its present form.

5.15 p.m.

Mr. David Crouch: The debate has taken a certain shape. My hon. Friend the Member for The Wrekin (Dr. Trafford) has brought us to the nub of the question; namely, that the Opposition have put forward a clause which is far too woolly to be added to the Bill.
I have great sympathy with the intentions enshrined in the clause, which is directed towards stress resulting from certain operations in industry. However, we must be clear what we are talking about when we refer to an occupational health scheme. There seem to be two sides. One aspect concerns the health of an individual as he performs his job; that is, his treatment if he should be injured or taken ill at work. The other aspect is the study of the causes that might produce illness over a relatively long period.
Yesterday I visited the Ford factory at Dagenham. One of the first things I was shown was the medical centre in the engine plant. That medical centre was


essentially for taking care of people who had knocked, cut, or bruised themselves or had perhaps fainted. A resident doctor and nurses were present. The facilities were excellent, as one might expect. However, I am sure that that doctor has not been consulted by the management about the repetitive nature of the work being done by the men on the assembly line.

Mr. Mayhew: He ought to be.

Mr. Crouch: I agree. I have had considerable experience of work in factories, though not on the assembly line. I believe that a great deal of thought must be given to this matter. We cannot neglect it.
Is an occupational health scheme the right method and mode? Should we pass this matter over to the Department of Health and Social Security for supervision? Is not this a matter for industry? Is it not for the TUC and the CBI, the management of both sides of industry, to study these problems?
For example, when I asked one manager yesterday how many different jobs a man did on the assembly line in manufacturing a car, the answer was "One job." I said "I thought you varied the jobs so that there was an opportunity for a man to do a different job from day to day." He said, "Good heaven, no. That would slow up production, and they do not want to do more than one job."
Management is ruling according to production. Management is making decisions in industry according to the achievement of the greatest possible production for the greatest possible economy. It is not necessarily listening to the doctors. Therefore, the establishment of an occupational health scheme will not improve that situation. We can improve it by introducing the idea of stress problems caused by what a man is doing at work into the whole management study.
I know of some industries where the medical profession is closely consulted about this problem. For example, wherever there is toxicity in industry the doctors are consulted. For example, in a paint shop there are the Factory Acts and regulations regarding the protection of workers.
What the right hon. Gentleman is suggesting is that we should go beyond this and find out the effects of work itself, rather than just of toxicity, on a person's health. I go along with him on this, but if we introduced this woolly clause, this blanketing phrase about establishing an occupational health scheme, implying that the problem would thereby be taken care of, we should do more harm than good. I would therefore recommend that the House does not accept such a woolly suggestion.
At the same time, however, we cannot push aside the requirement for management and shop floor to take into account the real problems which exist in industry and can attack a person's health.

The Under-Secretary of State for Health and Social Security (Mr. Michael Alison): I think it was the hon. Member for Willesden, West (Mr. Pavitt) who last used the phrase—it may have been used also by the hon. Member for Plymouth, Sutton (Dr. David Owen)—about our paying lip service to the relevant ILO convention. We utterly refute this allegation. We in the Government, and, above all, in my Department, pay more than merely lip service to the notion of occupational health.
We are broadly, indeed actively, in sympathy with the concern expressed by the right hon. Member for Deptford (Mr. John Silkin)—I cannot say in full agreement with the terms of his clause, but in the associated exposition of the clause for doing everything possible to sustain, improve and develop the health and well-being of people in their place of work. Indeed, as I shall hope to show, we have not been slack or inactive in seeking to carry this cause forward.
But it would be a great advantage for the House to follow the line suggested by my hon. Friend the Member for The Wrekin (Dr. Trafford) and be a little more analytical than many hon. Members have been about the notion of an occupational health service. It has not been sufficiently analysed and there is some muddled thinking about it. The Robens Committee gave a useful lead when it said:
The rôle of occupational medicine can be understood only against the background of the general structure of health services in this country.


The main element is the personal and mainly curative work of the National Health Service, which is centred on the individual and the family and not in the place of work.
The second broad division of the health service is the environmental and preventive or public health service provided for the community as a whole. In occupational health, the working environment is of predominant importance, and it is engineers, chemists and others, rather than doctors, who have the expertise to change it.
I want to ask the House to reflect for a moment on the mainly curative personal health services which we deliver at present on the basis of the free general practitioner services, leading through to the free hospital provision associated with general practitioner referrals. I must agree with my hon. Friend the Member for Aylesbury (Mr. Raison) that there can be no question but that the personal family curative medical treatment, especially of personal health, is properly based at present as a priority in the family context and the general practitioner services.
It is arguable that a strong case could be made for extending and developing this, so that personal curative medical treatment was provided in other places as well as the family context. But what is beyond dispute is that there can be no justification for making a switch of emphasis from the present family-based structure of these personal curative services towards putting them into the places of work. We could not conceivably duplicate them, and in the absence of the power to duplicate them we must lay the primary emphasis for this aspect of personal curative treatment on treatment by the general practitioner in the family.
There are other aspects of this question than just the personal curative medical aspect. There are other things which doctors can, should and do do in an environmental or occupational way. Let me remind the House of what the Tunbridge Committee specified as the sort of activities that doctors and others might do in the proposed occupational health service for our own National Health Service.
Paragraph 8 of the Tunbridge Committee's Report says that an occupational

health service for hospital staff might include the following activities:
pre-employment medical examinations other routine medical examinations examination and advice on resettlement where necessary after sick absence maintenance of immunisation records maintenance of staff health records advice on environmental health and safety conditions, including planning of new buildings health and hygiene instruction research into health factors, sickness patterns, wastage, etc.".
These are all very proper and necessary aspects of an occupational health service, but they are not elements necessarily including the personal curative medical treatment for which priority must, we believe, be given to the family-based general practitioner service.
At the same time, we have not only paid lip service to the notion of the occupational health service in the terms that I have specified in that quotation; we have committed ourselves actively to promoting this service in the National Health Service. The hon. Member for Sutton talked about the evolution of the Labour Party's proposals in this field, but we are at least as committed as the Labour Party to the evolution of a pattern of occupational health service, in respect of this single NHS occupational health service.
Indeed, to quote from the circular that we sent out in 1971 in respect of the NHS occupational health service:
The recommendations"—
of the Tunbridge Committee, that is to say——
are far reaching and the pace of their implementation will have to be governed by the limitations of finance and manpower resources, on which there are many competing demands. There is also the need, which the Joint Committee emphasises, to test the practical effect of their proposals before a service of the kind recommended is introduced generally.
So there is nothing between us on this.
We think that there is a key and cardinal place for the notion of an occupational health service, not necessarily a personal curative medical régime, but the sort of activities outlined in the quotation I read; all we say is that we are bound to hasten slowly because resources are at stake here.
As to what sort of resources are at stake, I believe I am right in saying that about a third of the firms in industry have some sort of medical practitioner


associated with them in some way, perhaps full time, perhaps part time. We were advised in 1966 that if we were to try to increase the extent to which medical practitioners were active in industrial firms so as to cover the whole range of industrial firms—in other words, the other two-thirds as well—the cost would have been £20 million and the number of extra doctors needed would have been at least 2,000. That was in 1966.
5.30 p.m.
The House can calculate that the cost will be immeasurably greater today, certainly in financial terms and almost certainly in terms of medical manpower if we are to lay a proper emphasis on the basic family personal curative medical service. In order to expand the occupational health service with doctors doing slightly different kinds of medical work, of the sort that I have suggested, enormous increases in expenditure will have to be considered and very large transfers of medical practitioners into industry will have to be envisaged, or the attempt to recruit further doctors from overseas or other sources.
The practical difficulties cannot be ignored. With the best will in the world, we are bound to evolve in this direction. We are committed to evolving in our National Health Service, but we shall evolve slowly, unavoidably, because the proper priority must rest with the family doctor health service.
I think that the hon. Member for Woolwich, East (Mr. Mayhew) appreciates the priorities which my right hon. Friend postulated in the latest White Paper on public expenditure, in which he said:
There will continue to be special emphasis on services for the elderly, the mentally ill, the mentally handicapped and the physically disabled including the younger disabled requiring long-term care; and additional emphasis will be given to services for alcoholics and homeless single people. It is also intended that family planning services provided under the National Health Service should be substantially expanded in order to reduce the distress caused by regretted pregnancies.
I could continue ad infinitum reminding the House of all the other claims that there are upon the 2,000 doctors who might have to be moved into industry so that all firms are covered by a doctor.
Whatever claims there are on this expenditure of over £20 million and on over 2,000 medical practitioners, there is yet a further subdivision which one could make in the notion and content of the phrase "occupational health service". This is the aspect which comes into view when we consider the Employment Medical Advisory Service; that is, the kind of work connected with the surveillance of workmen and workwomen to determine whether they are affected by their work.
We are deeply in sympathy with the point made by the hon. Member for Woolwich, East. The surveillance of workers at work, be they men or women, and the effect upon them of their conditions and environment and the character of their work, is of enormous and vital importance. We make no bones about this. We are entirely in sympathy with the point of view that the hon. Gentleman expressed. This is associated in the EMAS with such undertakings as the definition of criteria for safe working, advice on placement in work to ensure efficiency, and so on. Here again, we are more than in sympathy with what the hon. Member has brought forward in this notion of stress at work.
I can again give the House some reasonable grounds for encouragement here. The EMAS is very much a bipartisan measure. Both sides of the House are associated with it. It was a Labour Party measure in origin. We have implemented it. The Act received Royal Assent on 11th May last year, so it has only just got off the ground. But in this context there is a considerable number of doctors already employed or inherited from the former Medical Inspector of Factories, known as medical advisers. The EMAS inherited about 50 full-time staff. We propose to increase this to the equivalent of about 100 full-time doctors. So on this specific but rather narrow EMAS activity of the sort with which the hon. Gentleman is concerned—for example, the surveillance of stress—we have taken steps not only to implement the Act but to double the number of doctors we are proposing to employ in industry for this purpose.
It is estimated that when the service is fully operational there will be about 78 full-time doctors and 42 part-time


doctors. That is virtually a trebling of the number of medical personnel deployed through the EMAS. In addition to the doctors there will be a number of nurses and supporting administrative and clerical staff.
This is no paying of lip service to the notion of an occupational health service. Not only have we provided for such a service within the National Health Service, but we are determined to go forward as fast as we can. In the EMAS we are proposing to treble the number of doctors employed. However, we are very much in sympathy with my hon. Friend the Member for Aylesbury that the overriding priority must still rest with curative personal medical work associated with the family. This priority must remain.

Dr. Shirley Summerskill: Will the hon. Gentleman say whether the Government intend to retain the EMAS indefinitely under the Department of Employment? In December 1971 the Under-Secretary of State for Employment said when the National Health Service was reorganised, which we are in the process of doing at present, the proper home for the EMAS would undoubtedly have to be looked at again by the Department concerned. Are the Government looking at it again?

Mr. Alison: We are considering it. Subject to a correction which I shall have to give to the House on Report if I make a mistake, the present intention is that the EMAS should stay with the Department of Employment because many of its activities go wider than the employment of medical staffs. There are features associated with this aspect which overlap into the non-medical specialties, such as the work of chemists, physicists, engineers, and so on. If I am wrong in that I shall take action to correct it, but the present intention is that the EMAS should be part of the Department of Employment.
For these reasons we entirely refute the notion that we pay lip service to the idea of an occupational health service. On the contrary, we are not only trebling the number of doctors but setting up a service within the National Health Service.

Dr. Owen: Does the hon. Gentleman agree that the Government have reduced the number of doctors envisaged for the EMAS in the original Labour Party Bill? Did the Government say in evidence to the Robens Committee that they could not introduce an occupational health service within 10 years?

Mr. Alison: As far as I am aware, the evidence that we gave to that committee has not been published. I should not comment on that. I am not sure of the extent to which it is right that the hon. Gentleman should comment on that evidence. We never made any bones, nor do we today, about stressing that we believe in an occupational health service for the National Health Service. As was suggested in the departmental circular that I have read, we are hastening forward as rapidly as possible, in the same style as the hon. Gentleman has prayed in aid for the Labour Party's policies.
There is a very considerable measure of underlying agreement here, certainly in the realities of what we are trying to do. Very little divides us. We want an occupational health service and we are doing a great deal to provide one. But in terms of the words of the clause, I am bound to echo the fears expressed by my hon. Friend the Member for Canterbury (Mr. Crouch) that its drafting is rather woolly. I cannot recommend to the House that it should, by any stretch of the imagination, accept the clause. It is not clear from the words of the clause whether it is the Secretary of State who is to set up the extended occupational health service or whether the responsibility is to be laid upon industry. Certainly no powers are provided by which we could require industry to set this up. The clause does nothing more than urge us to do what we are doing already.

Mr. John Silkin: Perhaps the Under-Secretary will just take a little time to re-read the clause. I rise only to answer the "woolly" argument, because it was a woolly criticism. All that one is asking the Secretary of State to do, as the clause says very clearly—because we have at present a Conservative Secretary of State—is to take five years to look at what proposals are necessary in order to lay an


occupational health scheme before Parliament. A Labour Government would do it in two years.

Mr. Alison: That exposition of the nature of the clause may clarify some doubts about who is to be responsible for laying proposals, though it does not make clear who is to be responsible for implementing proposals.
The clause would impose no obligation upon the Secretary of State to implement proposals. It would merely require him to lay proposals. I am not sure that that would achieve very much in view of the amount that is already being done.
There are other defects. For example, the notion of industry as used in the clause is somewhat unsatisfactory. It is obviously borrowed from the standard industrial classification which has been used for quite different purposes than that of providing a proper structural basis for an occupational health service. We are limited to industries with at least 250,000 workers.
What might be sensible would be to provide an occupational health service within, say, a reasonable sized manufacturing town. This would be a rational and practical basis, perhaps, for providing an occupational health service, where there might be representative firms of half a dozen industries. Unfortunately, the clause would not enable us to make provision for an occupational health service along those lines. We could make provision for an occupational health service in only one of those firms—say, an engineering firm—in such a town and in another similar engineering firm in a town 10 miles away. That might be an entirely impracticable and irrelevant way to set about it.
It might be much more sensible to lay stress upon an occupational health service in a quite small firm connected with the manufacture of a toxic product. However, if such a firm were in a manufacturing or chemical industry below a certain size it would be excluded. For example, shipbuilding and marine engineering would be entirely excluded because of the provision as to the minimum number of workers, for those industries have only 183,000 workers. The clothing manufacturing industry could have an occupational health service because just by

chance it has a greater number of employees.

Mr. Silkin: There is nothing in the world to prevent the Secretary of State from going lower than that figure if he wishes. The purpose of the clause is to say that in the case of industries in which the total number of workers exceeds that figure he must act.

Mr. Alison: That is a lame explanation for putting a specific term in the clause, expecting the House to adopt one law for industries which happen to be above a certain size and an entirely permissive practice for industries which happen by complete chance to be much smaller.
The clause as presented is clearly unacceptable in drafting terms and, indeed, is nonsense when viewed analytically. However, I do not want to dwell upon that. I want to dwell on the common ground. The right hon. Gentleman expressed it with some eloquence. This is the concern we all have for the health and wellbeing of people—be they men or women—at their place of work, for it is a vital national interest.
In so far as resources permit, huge priority should be given, as indeed it is given in the Employment Medical Advisory Service, to promoting the specialist medical facilities which an occupational health service requires. We are committed to this in the National Health Service occupational scheme and we shall continue to try to expand these facilities as fast as resources permit.
Nevertheless, we must stress the overriding priority we are bound to give in present circumstances to the personal curative medical treatment provided by medical practitioners in the family context and in association with hospitals. Given that priority, we are bound to hasten perhaps slowly in an evolutionary way. In that we follow the tone and note of evolution which is so suitable to both sides of the House on this occasion.

Mr. Pavitt: The hon. Gentleman has made a strong case about the family-based medical service. What argument is there against transferring the conservation and treatment of teeth from the present system into an occupational health service? What more would it cost? What extra manpower would it require? None.

Mr. Alison: As the hon. Gentleman no doubt knows, there are many dentists already employed in private manufacturing concerns. They may even be employed in the nationalised industries, but I cannot speak with authority on that. In view of the criticism we are receiving about the extent to which dental practitioners are opting out of practice with the National Health Service, we should be greatly at risk of intensified criticism if we were to decide to encourage the redeployment of yet more family dental practitioners deliberately into manufacturing and commercial undertakings. I do not think that proposition is any more of a starter than is the transfer of family doctors into industry.

5.45 p.m.

Mr. George Thomas: The Under-Secretary has disappointed us. We listened to him in Committee on many occasions. When he had a thin case he managed to make the most of it and fill up the time. This afternoon he filled up the time but did not make the most of it. The Under-Secretary has revealed the wide gap there is between us. Taking away all the flannelling around those words, the essential point is that the Government decline to agree even to produce a plan within five years for an occupational health service.
The Under-Secretary adopted a very different attitude from that adopted by his hon. Friends. My hon. Friends, who presented impressive statistics, revealed without exception a tremendous knowledge of the National Health Service and advanced a positive case. There was just hostility to the idea of an occupational health service from the Minister's hon. Friends.
The hon. Member for The Wrekin (Dr. Trafford) was the most hostile of all. His approach was entirely negative. He had not one kind word to say for an occupational health service. I understand that the hon. Gentleman is engaged in the world of medicine. One would have expected at least a little more understanding of what an occupational health service means to workers from a man whose responsibility it is to care for the sick when he is not in the House.

Dr. Trafford: The right hon. Gentleman could not have been listening to

what I said. I was not in any way hostile to an occupational health service. I said briefly that the proposition contained in the clause was too woolly and that the right hon. Gentleman's hon. Friends had revealed that they had very differing concepts of an occupational health service. If the right hon. Gentleman likes to tell us—if he knows what he is talking about—precisely what is entailed, we will listen with the greatest of interest, but it is nonsense for him to say that we are hostile when he has not told us precisely what it is that is intended.

Mr. Thomas: The hon. Gentleman has been in the House just as long as it will take us to introduce an occupational health service—just over two years. He made a great mistake this afternoon. He had nothing constructive to say. I believe that he was asked to speak so that there should be a speaker from the Conservative benches. The hon. Gentleman spent his time saying that the clause is woolly, that it is nothing more definite than a call on the Secretary of State to produce within five years his plan for an occupational health service. There is nothing woolly about that. If the hon. Gentleman cannot understand that, I can only say that it looks to me as if he will make a similar contribution in the House to that of his predecessors in that constituency. I could hardly be more unkind.

The Minister of State, Welsh Office (Mr. David Gibson-Watt): Will the right hon. Gentleman give way?

Mr. Thomas: Is it a contribution on this subject or an answer to my comments to the hon. Member for The Wrekin?

Mr. Gibson-Watt: May I ask the right hon. Gentleman a question? Was the right hon. Gentleman referring to my hon. Friend's Labour predecessor or a Conservative Member who came before?

Mr. Thomas: I was referring to the Arab. We all know who that was. I certainly was not referring to any Labour man, and I am grateful to the Minister of State for giving me the chance to make that clear. I was thinking back to that oddity. However, let us leave that.
It was difficult to gather from the Minister's speech this afternoon that the


British Medical Association and the Trades Union Congress have asked for the proposal that we are putting forward. It was hard to judge from speeches from the Conservative side that the medical profession does not think this proposal woolly or that it will damage the rest of the health service. My hon. Friend the Member for Plymouth, Sutton (Dr. David Owen) is a distinguished member of the medical profession and he indicated that the general practitioner could be greatly helped by an occupational health service. The efficiency of the family service will be improved because the family doctor who is unable to probe into the causes of complaints with which he has to deal will be helped by those who devote themselves as experts to this task. Although the occupational health service is far more than just an accident-at-work service, we in Wales, as the Minister of State will know, have a special cause for hoping for a national occupational health service. Wales has 5 per cent. of the United Kingdom population, but 9·4 per cent. of injury benefit and 12·7 per cent. of disablement benefit are paid in Wales. This is largely owing to the heavier industries and to the more dangerous nature of much of the industry there.
The Under-Secretary in opposing the clause did not present many convincing arguments but he said that he was in favour of the general idea but was unwilling to give a date or time for producing a comprehensive plan for this service. All that the Under-Secretary and the Government can do today is to delay the matter. When we have a Labour Government we shall introduce this scheme, and within two years we hope we shall have had the reports of working parties which we shall set up in every region. Employers and workers will he represented on these working parties, which will also include representatives of the health service, the local authorities, the medical profession and especially those concerned with the care of people at work. We shall undertake a complete survey so that comprehensive plans can be presented to the House indicating the

ways in which we can make the most effective use of our resources.

My right hon. and hon. Friends have made one point which the Minister did not attempt to answer. I hope that the survey which we propose of every region and of every industry in every region will help us to find the fields of research that are an essential part of an occupational health service. Many of my right hon. and hon. Friends have been engaged in industry, not in the board room or in the manager's office, but at the bench as skilled craftsmen. I am not speaking for myself, because I served in the classroom as everyone knows. I only wish that I had the chance to teach the Minister of State something, but that was his misfortune as well as my——

Mr. Alec Jones: Good luck?

Mr. Thomas: Thank you. My right hon. and hon. Friends have served in industry as skilled craftsmen, as miners and as railwaymen, and we therefore see this problem in a different light from the Government. We therefore, commit ourselves to increasing the amount which will be spent on research into health hazards for people at work. We all know that these hazards have increased, are increasing and will continue to increase and so we see this as a major issue.
My right hon. and hon. Friends will have no hesitation in going into the Lobby in support of our belief that an occupational health service is a natural development in the National Health Service. The Bill seeks to reorganise the whole of the National Health Service after 25 years. It has now been proved that millions of workers in industry require this service on grounds both of efficiency and personal happiness. The Government may stop us today but once we are returned to power an occupational health service will be introduced.

Question put, That the clause be read a Second time:—

The House divided: Ayes 249, Noes 270.

Division No. 147.]
AYES
[6.00 p.m.


Abse, Leo
Ashley, Jack
Barnes, Michael


Allaun, Frank (Salford, E.)
Ashton, Joe
Barnett, Joel (Heywood and Royton)


Archer, Peter (Rowley Regis)
Atkinson, Norman
Baxter, William


Armstrong, Ernest
Bagier, Gordon A. T.
Beaney, Alan




Benn, Rt. Hn. Anthony Wedgwood
Grimond, Rt. Hn. J.
Orme, Stanley


Bennett, James(Glasgow, Bridgeton)
Hamling, William
Oswald, Thomas


Bidwell, Sydney
Hannan, William (G'gow, Maryhill)
Owen, Dr. David (Plymouth, Sutton)


Bishop, E. S.
Hardy, Peter
Padley, Walter


Blenkinsop, Arthur
Harrison, Walter (Wakefield)
Paget, R. T.


Boardman, H. (Leigh)
Hart, Rt. Hn. Judith
Palmer, Arthur


Booth, Albert
Hattersley, Roy
Pannell, Rt. Hn. Charles


Boothroyd, Miss B. (West Brom.)
Healey, Rt. Hn. Denis
Pardoe, John


Bottomley, Rt. Hn. Arthur
Horam, John
Parker, John (Dagenham)


Boyden, James (Bishop Auckland)
Houghton, Rt. Hn. Douglas
Parry, Robert (Liverpool, Exchange)


Broughton, Sir Alfred
Howell, Denis (Small Heath)
Pavitt, Laurie


Brown, Hugh D. (G'gow, Provan)
Huckfield, Leslie
Peart, Rt. Hn. Fred


Buchan, Norman
Hughes, Rt. Hn. Cledwyn (Anglesey)
Perry, Ernest G.


Buchanan, Richard (G'gow, Sp'burn)
Hughes, Mark (Durham)
Prentice, Rt. Hn. Reg.


Butler, Mrs. Joyce (Wood Green)
Hughes, Robert (Aberdeen, N.)
Prescott, John


Callaghan, Rt. Hn. James
Hughes, Roy (Newport)
Price, William (Rugby)


Campbell, I. (Dunbartonshire, W.)
Irvine, Rt. Hn. Sir Arthur (Edge Hill)
Probert, Arthur


Cant, R. B.
Jay, Rt. Hn. Douglas
Radice, Giles


Carmichael, Neil
Jeger, Mrs. Lena
Reed, D. (Sedgefield)


Carter, Ray (Birmingh'm, Northfield)
Jenkins, Hugh (Putney)
Rees, Merlyn (Leeds, S.)


Carter-Jones, Lewis (Eccles)
Jenkins, Rt. Hn. Roy (Stechford)
Rhodes, Geoffrey



John, Brynmor
Roberts, Albert (Normanton)


Castle, Rt. Hn. Barbara
Johnson, Carol (Lewisham, S.)
Roberts, Rt.Hn.Goronwy (Caernarvon)


Clark, David (Colne Valley)
Johnson, James (K'ston-on-Hull, W.)
Robertson, John (Paisley)


Cocks, Michael (Bristol, S.)
Johnson, Walter (Derby, S.)
Roderick, CaerwynE.(Brc'n&amp;R'dnor)


Cohen, Stanley
Johnston, Russell (Inverness)
Rodgers, William (Stockton-on-Tees)


Coleman, Donald
Jones, Barry (Flint, E.)
Roper, John


Concannon, J. D.
Jones, Dan (Burnley)
Rose, Paul B.


Corbet, Mrs. Freda
Jones, Gwynoro (Carmarthen)
Ross, Rt. Hn. William (Kilmarnock)


Cox, Thomas (Wandsworth, C.)
Jones, T. Alec (Rhondda, W.)
Rowlands, Ted


Crawshaw, Richard
Kaufman, Gerald
Sandelson, Neville


Cronin, John
Kelley, Richard
Sheldon,Robert (Ashton-under-Lyne)


Crosland, Rt. Hn. Anthony
Kinnock, Neil
Shore, Rt. Hn. Peter (Stepney)


Crossman, Rt. Hn. Richard
Lambie, David
Short, Mrs. Renée (W'hampton,N.E.)


Cunningham, Dr. J. A. (Whitehaven)
Lamborn, Harry
Silkin, Rt. Hn. John (Deptford)


Dalyell, Tam
Lamond, James
Silkin, Hn. S. C. (Dulwich)


Darling, Rt. Hn. George
Latham, Arthur



Davidson, Arthur
Lawson, George
Sillars, James


Davies, Denzil (Lianelly)
Lee, Rt. Hn. Frederick
Silverman, Julius


Davies, G. Elfed (Rhondda, E.)
Leonard, Dick
Skinner, Dennis


Davies, Ifor (Gower)
Lewis, Arthur (W. Ham, N.)
Small, William


Davis, Clinton (Hackney, C.)
Lewis, Ron (Carlisle)
Smitn, cyril (Rochdale)


Davis, Terry (Bromsgrove)
Lipton, Marcus
Soref, Harold


Deakins, Eric
Lomas, Kenneth
Spearing, Nigel


de Freitas, Rt. Hn. Sir Geoffrey
Loughlin, Charles
Spriggs, Leslie


Delargy, Hugh
Lyons, Edward (Bradford, E.)
Stallard, A. W.


Dell, Rt. Hn. Edmund
McBride, Neil
Steel, David


Dempsey, James
McCartney, Hugh
Stewart, Rt. Hn. Michael (Fulham)


Doig, Peter
McElhone, Frank
Stoddart, David (Swindon)


Dormand, J. D.
McGuire, Michael
Stonehouse, Rt. Hn. John


Douglas, Dick (Stirlingshire, E.)
Machin, George
Strauss, Rt. Hn. G. R.


Driberg, Tom
Mackenzie, Gregor
Summerskill, Hn. Dr. Shirley


Duffy, A. E. P.
Mackie, John
Swain, Thomas


Dunn, James A.
Maclennan, Robert
Thomas,Rt.Hn.George (Cardiff,W.)


Dunnett, Jack
McMillan, Tom (Glasgow, C.)
Thomas, Jeffrey (Abertillery)


Edelman, Maurice
McNamara, J. Kevin
Thorpe, Rt. Hn. Jeremy


Edwards, Robert (Bilston)
Mahon, Simon (Bootle)
Tinn, James


Edwards, William (Merioneth)
Mallalieu, J. P. W. (Huddersfield, E.)
Tomney, Frank


Ellis, Tom
Marquand, David
Tope, Graham


English, Michael
Marsden, F.
Torney, Tom


Evans, Fred
Mason, Rt. Hn. Roy
Tuck, Raphael


Ewing, Harry
Mayhew, Christopher
Varley, Eric G.


Fernyhough, Rt. Hn. E.
Meacher, Michael
Wainwright, Edwin


Fisher,Mrs.Doris(B'ham, Ladywood)
Mellish, Rt. Hn. Robert
Walden, Brian (B'ham, All Saints)


Fletcher, Raymond (Ilkeston)
Mendelson, John
Walker, Harold (Doncaster)


Fletcher, Ted (Darlington)
Mikardo, Ian
Wallace, George


Foot, Michael
Millan, Bruce
Watkins, David


Ford, Ben
Miller, Dr. M. S.
Weitzman, David


Forrester, John
Milne, Edward
Wellbeloved, James


Fraser, John (Norwood)
Mitchell, R. C. (S'hampton, Itchen)
White, James (Glasgow, Pollok)


Freeson, Reginald
Molloy, William
Whitehead, Phillip


Galpern, Sir Myer
Morgan, Elystan (Cardiganshire)
Whitlock, William


Garrett, W. E.
Morris, Alfred (Wythenshawe)
Williams, Alan (Swansea, W.)


Gilbert, Dr. John
Morris, Charles R. (Openshaw)
Williams, W. T. (Warrington)


Ginsburg, David (Dewsbury)
Morris, Rt. Hn. John (Aberavon)
Wilson, Rt. Hn. Harold (Huyton)


Golding, John
Moyle, Roland
Woof, Robert


Gordon Walker, Rt. Hn. P. C.
Oakes, Gordon



Gourlay, Harry
O'Halloran, Michael
TELLERS FOR THE AYES:


Grant, George (Morpeth)
O'Malley, Brian
Mr. Joseph Harper and Mr. James Hamilton.


Grant, John D. (Islington, E.)
Oram, Bert



Griffiths, Eddie (Brightside)
Orbach, Maurice








NOES


Adley, Robert
Gardner, Edward
Mills, Peter (Torrington)


Alison, Michael (Barkston Ash)
Gibson-Watt, David
Miscampbell, Norman


Allason, James (Hemel Hempstead)
Gilmour, Ian (Norfolk, C.)
Mitchell, David (Basingstoke)


Amery, Rt. Hn. Julian
Glyn, Dr. Alan
Money, Ernie


Archer, Jeffrey (Louth)
Godber, Rt. Hn. J. B.
Monks, Mrs. Connie


Astor, John
Goodhart, Philip
Monro, Hector


Atkins, Humphrey
Gorst, John
More, Jasper


Awdry, Daniel
Gower, Raymond
Morgan-Giles Rear-Adm.


Baker, Kenneth (St. Marylebone)
Grant, Anthony (Harrow, C.)
Mudd, David


Baker, W. H. K. (Banff)
Gray, Hamish
Murton, Oscar


Balniel, Rt. Hn. Lord
Green, Alan
Nabarro, Sir Gerald


Barber, Rt. Hn. Anthony
Grieve, Percy
Neave, Airey


Batsford, Brian
Griffiths, Eldon (Bury St. Edmunds)
Nlcholls, Sir Harmar


Beamish, Col. Sir Tufton
Grylls, Michael
Noble, Rt. Hn. Michael


Bennett, Sir Frederic (Torquay)
Gummer, J. Selwyn
Normanton, Tom


Bennett Dr. Reginald (Gosport)
Gurden, Harold
Nott, John


Benyon, W.
Hall, Miss Joan (Keighley)
Onslow, Cranley


Berry, Hn. Anthony
Hall-Davis, A. G. F.
Oppenheim, Mrs. Sally


Biffen, John
Hamilton, Michael (Salisbury)
Orr, Capt. L. P. S.


Biggs-Davison, John
Hannam, John (Exeter)
Page, Rt. Hn. Graham (Crosby)


Blaker, Peter
Harrison, Brian (Maldon)
Parkinson, Cecil


Boardman, Tom (Leicester, S.W.)
Harrison, Col. Sir Harwood (Eye)
Percival, Ian


Body, Richard
Haselhurst, Alan
Pike, Miss Mervyn


Boscawen, Hn. Robert
Hastings, Stephen
Pink, R. Bonner


Bowden, Andrew
Havers, Sir Michael
Pounder, Rafton


Bray, Ronald
Hawkins, Paul
Powell, Rt. Hn. J. Enoch


Brown, Sir Edward (Bath)
Heseltine. Michael
Price, David (Eastleigh)


Bruce-Gardyne, J.
Higgins, Terence L.
Prior, Rt. Hn. J. M. L.



Hiley, Joseph
Proudfoot, Wilfred


Bryan, Sir Paul
Hill, John E. B. (Norfolk, S.)
Pym, Rt. Hn. Francis


Buchanan-Smith, Alick(Angus,N&amp;M)
Hill, S. James A. (Southampton, Test)



Buck, Antony
Holland, Philip
Quennell, Miss J. M>


Bullus, Sir Eric
Holt, Miss Mary
Raison, Timothy


Burden F. A.

Ramsden, Rt. Hn. James


Butler, Adam (Bosworth)
Hordern, Peter
Rawlinson, Rt. Hn. Sir Peter


Campbell, Rt.Hn.G. (Moray &amp; Nairn)
Hornby, Richard
Redmond, Robert



Hornsby-Smith,Rt.Hn.Dame Patricia
Reed, Laurence (Bolton, E.)


Carlisle, Mark
Howe, Rt. Hn. Sir Geoffrey



Carr, Rt. Hn. Robert
Howell, David (Guildford)
Rees Peter, (Dover)


Chapman, Sydney
Howell, Ralph (Norfolk, N.)
Rees-Davies, W. R.


Chataway, Rt. Hn. Christopher
Hunt, John
Renton, Rt. Hn. Sir David


Chichester-Clark, R.
Hutchison Michael Clark
Rhys Williams, Sir Brandon


Churchill, W. S.
Iremonger, T.L.
Ridley, Hn. Nicholas


Clark, William (Surrey, E.)
Irvine Bryant Godman (Rye)
Rippon, Rt. Hn. Geoffrey


Clegg, Walter
James David
Roberts Wyn, (Conway)


Cockeram, Eric
Jenkin, Patrick (Woodford)
Rodgers, Sir John (Sevenoaks)


Cooke, Robert
Jessel Toby
Rossi, Hugh (Hornsey)


Coombs, Derek
Johnson Smith, G. (E. Grinstead)
Rost, Peter


Cooper, A. E.
Jones Arthur (Northants, S.)
Royle, Anthony


Cordie, John
Jopling, Michael
Russell, Sir Ronald


Corfield, Rt. Hn. Sir Frederick
Joseph, Rt. Hn. Sir Keith
St. John-Stevas, Norman


Cormack, Patrick
Kaberry, Sir Donald
Sandys, Rt. Hn. D.


Costain, A. P.
Kellett-Bowman, Mrs. Elaine
Scott, Nicholas


Critchley, Julian
Kimball, Marcus
Scott-Hopkins, James


Crouch, David
King, Evelyn (Dorset, S.)
Shaw, Michael (Sc'b'gh &amp; Whitby)


Dalkeith, Earl of
Kirk, Peter
Shelton, William (Clapham)


d'Avigdor-Goldsmid, Sir Henry
Kitson, Timothy
Shersby, Michael


d'Avigdor-Goldsmid,Maj.-Gen.Jack
Knight, Mrs. Jill
Simeons, Charles


Dean, Paul
Knox, David
Sinclair, Sir George


Digby, Simon Wingfleld
Lamont, Norman
Skeet, T. H. H.


Dixon, Piers
Lane, David
Smith, Dudley (W'wick &amp; L'mington)


Dodds-Parker, Sir Douglas
Langford-Holt, Sir John
Soref, Harold


Douglas-Home, Rt. Hn. Sir Alec
Le Merchant, Spencer
Speed, Keith


Drayson, G. B.
Lloyd,Rt.Hn.Geoffrey(Sut'nC'field)
Spence, John


du Cann, Rt. Hn. Edward
Lloyd, Ian (P'tsm'th, Langstone)
Sproat, Iain


Dykes, Hugh
Loveridge, John
Stewart-Smith, Geoffrey (Belper)


Eden. Rt. Hn. Sir John
McAdden, Sir Stephen
Stodart, Anthony (Edinburgh, W.)


Edwards, Nicholas (Pembroke)
McCrindle, R. A.
Stokes, John


Elliot, Capt. Walter (Carshalton)
McLaren, Martin
Stuttaford, Dr. Tom


Elliott, R. W. (N'c'tle-upon-Tyne,N.)
Maclean, Sir Fitzroy
Sutcliffe, John


Emery, Peter
McMaster, Stanley
Tapsell, Peter


Eyre, Reginald
Macmillan,Rt.Hn.Maurice(Farnham)
Taylor, Sir Charles (Eastbourne)


Farr, John
McNair-Wilson, Michael
Taylor, Edward M. (G'gow.Cathcart)


Fenner, Mrs. Peggy
McNair-Wilson, Patrick (New Forest)
Taylor, Frank (Moss Side)


Fidler, Michael
Maddan, Martin
Taylor, Robert (Croydon, N.W.)


Finsberg, Geoffrey (Hampstead)
Madel, David
Tebbit, Norman


Fisher, Nigel (Surbiton)
Marples, Rt. Hn. Ernest
Temple, John M.


Fookes, Miss Janet
Marten, Neil
Thatcher, Rt. Hn. Mrs. Margaret


Fortescue, Tim
Mather, Carol
Thomas, Rt. Hn. Peter (Hendon, S.)


Foster, Sir John
Maude, Angus
Thompson, Sir Richard (Croydon, S.)


Fowler, Norman
Maudling, Rt. Hn. Reginald
Tilney, John


Fox, Marcus
Mawby, Ray
Trafford, Dr. Anthony


Fraser,RtHn.Hugh(St'fford &amp; Stone)
Maxwell-Hyslop, R. J.
Trew, Peter


Galbraith, Hn. T. G. D.
Meyer, Sir Anthony
Tugendhat, Christopher







Turton, Rt. Hn. Sir Robin
Ward, Dame Irene
Woodnutt, Mark


van Straubenzee, W. R.
Warren, Kenneth
Worsley, Marcus


Vaughan, Dr. Gerard
Weatherill, Bernard
Wylie, Rt. Hn. N. R.


Vickers, Dame Joan
Wells, John (Maidstone)



Waddington, David
Wiggin, Jerry
TELLERS FOR THE NOES:


Walder, David (Clitheroe)
Wilkinson, John



Walker, Rt. Hn. Peter (Worcester)
Winterton, Nicholas
Mr. John Stradling Thomas and Mr. Kenneth Clarke.


Walker-Smith, Rt. Hn. Sir Derek
Wolrige-Gordon, Patrick



Walters, Dennis
Woodhouse, Hn. Christopher

Question accordingly negatived.

New Clause 2

NEIGHBOURHOOD HEALTH COUNCILS

"(1) The Secretary of State shall on an application in writing made to him by the council of a local authority district, being a district the area or part of the area of which is co-extensive with the area of a parish or community (as defined by the Local Government Act 1972), direct that there shall be a neighbourhood health council for the said parish or community on and after 1st April 1975.

(2) The Secretary of State may, without any application under subsection (1) above but after such consultations as he thinks proper, direct, not later than 1st April 1975, that there shall be a neighbourhood health council for any parish or community as is referred to in subsection (1) above if he is satisfied that the conditions laid down in subsection (1) exist.

(3) It shall be the function of a neighbourhood health council to represent the views of the parish or community with regard to the operation of the health service in their area.

(4) Subject to subsection (3) above, the Secretary of State shall by regulation lay down the composition and functions of such neighbourhood health councils".—[Mr. Blenkinsop.]

Brought up, and read the First Time.

6.10 p.m.

Mr. Arthur Blenkinsop: I beg to move, That the clause be read a Second time.
I trust that I shall have the leave of the House in moving the clause with a minor change in the wording from the clause as tabled, which referred purely to Wales. It is my intention that the clause should apply to Great Britain as a whole. That I have achieved by inserting the words "parish or" before the word "community" wherever it appears. It is a minor change. The principle remains identical. It would be for the benefit of the House to agree to that inclusion. I take it that there is no objection to that being done.

Mr. Gibson-Watt: I do not see any of the hon. Gentleman's Welsh hon. Friends behind him at present. Can he assure

me that some of his Welsh hon. Friends will be speaking on the new clause? Because of the way in which it has been worded I, as Minister of State for Wales, will reply.

Mr. Blenkinsop: We accept that the hon. Gentleman intends to reply. There was great anxiety that the admirable proposals put forward for Wales—this was the position when the Local Government Bill was being considered—should be made full use of for England. Unfortunately, that was not accepted when the Local Government Bill was considered. In order that the point that we are raising should clearly be seen to apply to the whole of Great Britain, I move the amendment that I have described. I take no offence because the hon. Gentleman intends to reply. This is an instance when the word "community" relates particularly to Wales. It is unhappy and unfortunate that it should not also apply to England.
I wish to refer to the House to the stimulating and interesting intervention of my right hon. Friend the Member for Deptford (Mr. John Silkin) in Committee when we discussed Clause 9, which refers to community health councils. My right hon. Friend made clear our deep anxiety and concern about the provision for the establishment of community health councils. He made clear that that opposition was fundamental. The Opposition dislike the whole provision, because it refers to an appointed as against an elected body. We dislike it because it is likely to relate to a larger area than we believe suitable. We dislike it, in particular, because of the problems which such a provision must create.
There is no doubt about our views on the overall proposition put forward in the Bill and the kind of National Health Service that is likely to develop under the Bill's provisions. The pattern proposed is a managerial pattern, which is unsuitable for the health service. It is rigid and damaging in many respects. I noticed the effective letter in The Times


from my hon. Friend the Member for Halifax (Dr. Summerskill). It is because we fear the dangers of this kind of health service organisation that we want to ensure that there is an effective challenge or voice from the ordinary people who are using the health service as well as those working in it.
We profoundly doubt whether any kind of challenge can be developed to the community health councils as proposed in the Bill. The Minister may say that he takes power to establish a community health council in areas no larger than a district. Indeed, he made that point when the matter was discussed in Committee. He said that it was his intention to try to ensure that the areas would not necessarily be the same as the area health authorities, although in some cases the area health authorities may run in parallel with the new districts in metropolitan areas. He said that elsewhere they would not.
6.15 p.m.
The Minister made it clear that it was his intention to ensure that there was provision at a district level. So far, so good. In our view, as my right hon. Friend the Member for Deptford said, that is by no means good enough. We still regard the districts in most cases as areas far too large for proper representation of the public's point of view. If there is anxiety about the workings of the health service, we must ensure that in future it can be voiced by people at a real neighbourhood or local level.
Many of us have made the case vigorously, in the House and in Committee, for the establishment of neighbourhood councils. We were modestly encouraged by the fact that the Local Government Act did not specifically prevent neighbourhood councils from being established. Indeed, in a sense it gave authority for that to happen by way of what might be called an urban policy if a district council should wish to establish such a council.
There are examples of district councils electing neighbourhood councils which are to be established in London and, we hope, in other parts of the country. How encouraging it would have been had the opportunity been taken to give the new concept of local bodies the authority and right to intervene and ex-

press opinions on health service issues which are of paramount concern to people living in an intimate area in the immediate neighbourhood.
It can be envisaged that as we develop health centres there will be a natural and suitable link between those centres and the local communities around them. The health centres provide for some of the initial contact of ordinary people about their health needs. It is to be hoped that not only their direct medical health needs but some of their social needs will be met rather more widely. What could be better than to encourage the link between the local communities and the health centres and the wider health services around the centres? In that way, we could really get an uninhibited local voice about what was happening.
We are told by the right hon. Gentleman that he is proposing to set up community health councils. He tells us that he is ensuring that there will be provision on those councils for representatives of locally elected authorities. We think they should be locally elected people. We believe this is an area where a locally elected member ought to have his full voice and full authority.
As matters stand, the representatives will be appointed. The right hon. Gentleman says that almost certainly the appointments will not be directly made by him. Indeed, a good deal of humour was caused in Committee in trying to work out how he might conceivably do the job of making appointments to all the bodies being established. We are told that the appointments are likely to be made by the regional body. That does not encourage us very much. We do not believe it helps the kind of case that we are concerned about. We say that the Government are imposing an authoritarian system on the health service. Therefore, we want all the more to ensure that there is an elected body to make effective complaint.
We put forward in the new clause modest proposals. We would prefer the local district authority to make the application or proposal for the small authority for the neighbourhood to be established. But if the district did not do this—if it were for any reason unwilling to do it, the Secretary of State could step in to act. Powers would be reserved to


enable him to specify the detailed functions of the new neighbourhood health council, its composition and its functions, but it is our clear intention that it should be a locally elected body.
In our view, this is an exciting opportunity for us to introduce this new kind of public intervention. We wanted to see it included in the Local Government Act. We were denied that full opportunity, though there may be some experiments. This is an area where, above all else, local, people should have a new opportunity of expressing themselves.
We fear very much that, even with the best will in the world and with the best efforts of the right hon. Gentleman to select representatives from a wide range of voluntary and other bodies, there will be the suspicion in the minds of local people that this is just another part of the establishment. We want to see a breakthrough, a new opportunity for local people to express themselves.
We often hear in the House, unhappily, that there is a good deal of cynicism, especially among younger people, about the functioning of some of our authorities. Here, surely, is a way in which we can introduce an opportunity for fresh expression of ideas. It is on that basis that I move the new clause with the modest amendment of inserting "parish or" in front of the word "community", where that word appears.

Mr. Lomas: I know that I am sitting on the horns of dilemma, and may well be close to being out of order, but it will not be for more than three or four minutes. This is the only way in which it is possible to express, on Report, my view, which I sought to put over in Committee during many arguments and discussions, on the composition of the various types of authorities. It has been ruled by you, Sir, that Amendment No. 52 should not be called this afternoon. That concerned itself with the composition of the regional health authorities. I stress that in my opinion the nuts and bolts of the Bill is really the composition of the regional area and other committees. What I hoped we would do was to ensure that on the area and regional committees non-medical and ancilliary workers, nurses and midwives and the medical profession would be represented

in the functional councils of the Whitley system. That has not been possible. I declare an interest as a sponsored Member of Parliament in respect of the National Union of Public Employees.
Recently, at the union's annual conference at Eastbourne, it passed a resolution in strong terms:
That this conference calls upon the Executive Council to do all within its power to introduce amendments to the Act reorganising the National Health Service to ensure the adequate representation of all Health Service employees, including ancillary staffs and trade unions, on the new health councils and area health authorities.
There is a strong case for such representation on the new bodies proposed in new Clause 2. Those in the health service who constitute about one-fifth of the labour force have been praised by hon. Members opposite many times and we are grateful for their comments. These workers have had a lot of tributes but not a lot of money. Earlier this year, the Under-Secretary of State said:
The hospital ancillary worker has a crucial role to play in the complex range of services performed by a hospital in securing the patient's full restoration to health. It is none the less vital for being less spectacular and glamorous than the role of the nurse or the doctor."—[OFFICIAL REPORT, 31st January 1973; Vol 849, c. 1410.]
I therefore fully support new Clause 2, particularly subsection (3) which says that
It shall be the function of a neighbourhood health council to represent the views of the community with regard to the operation of the health service in their area.
We must pay some regard to the views of those who work in our hospitals, and who are involved in the day-to-day running of the health service, because without them the service would collapse. Equally, there is a case for some kind of representation from local authorities. The Huddersfield Trades Council made that abundantly clear in a resolution it sent to me recently, advocating that there should, for example, be at least two full members elected to the area health authority. I accept that the type of council now under discussion is low down the scale in terms of decision-making, but this would be at least some form of participation.
When we talk of the National Health Service we sometimes forget the patients, although they are the most important people in it. We should find some


method of ensuring that their voice is heard. The simple way, at all levels of the structure of the NHS, to ensure that the workers and others involved are represented adequately is to make provision for each of the functional Whitley Councils to appoint a member. That should be left to the various unions to decide. Indeed, this should apply at all levels in all the various parts of the NHS. I hope that I shall have an opportunity on Third Reading to say more about that aspect of it.

6.30 p.m.

Mr. Edward Rowlands: As I did not have the pleasure of serving on the Committee, this is the first opportunity I have had of speaking on the Bill. I believe the debates in Committee and now on Report show that the Bill misses the very point which should be dealt with. It should be a question not of managerial decision in the three arms of the service, but of a new definition of the relationship between members of the public, as patients, and the administrative staffs and the medical profession. That is essential to the whole reorganisation of the service, but it is missing from every aspect of the Bill. Indeed, the Bill appears to have been specially designed to avoid trying to deal with the new relationship.
For far too long a whole generation of people were so grateful for the service that they accepted the minimum from it, but now a new generation has come along and those in that generation feel that they have rights in the health service and have not just to express gratitude for some sort of service rendered to them. That is the basis on which we judge the proposals in the Bill. Gone are the days when the medical profession and medical administrators could expect such an attitude. Gone is the day when we were expected to be grateful if the doctor turned up and dealt with a complaint, or a consultant deigned to act on our behalf. That is the reason why this new clause is so necessary. The Bill avoids all these issues and prevents the views and opinions of the public and patients from being fully expressed and heard throughout the administration.
I am afraid that in many cases the image of the medical consultant is still that of James Robertson Justice—a

"Carry On" sort of consultant who marches down the ward as if patients are something ancillary to his pride and importance. At the out-patient department level patients can sit waiting for hours without receiving a word of explanation of why they have to wait, and why appointments have not been kept. Often those in authority do not have the courtesy to explain why those patients have had to wait. My hon. Friend the Member for South Shields (Mr. Blenkinsop), opening the debate on this issue, spoke about health centres. A large number of GPs, against the wishes of their own patients, will not work in health centres. They will not establish a decent group practice to provide the best cover and service for a local community. We have the right now to expect much more from the service, and that it should be more accountable and more sensitive to the wishes of the public. Because of that a clause of this nature is necessary.
I am afraid that in some areas the methods of representation adopted after 1947 have proved a failure. Some hospital management committees have not been the sort of power of local representation they should have been. In most cases I am afraid the committees have been ruled by the group secretary. At local GP level there is not a sufficient system of accountability, or a sufficient feeling of relationship between patients and GPs. As a result, there are many complaints such as that of a pregnant woman who has to wait for hours in an ante-natal clinic. There are growing complaints from a large number of people about the way in which GPs fail to perform their services to the community, and those complaints go unheard. The medical profession ought to start listening to what is being said—not loudly but quietly—in informal discussions. General practitioners are not held in the same reverence as they might believe.
Because we need to establish a new relationship between the public and the service—between the patient and the medical profession—this clause is necessary. I should have liked the rôle of the health councils to be spelled out in greater detail. I do not want their functions to be dictated and determined by the Secretary of State. They should have been included in this clause. The whole of these health councils elected by the


people locally, should be the chief instrument for dealing with individual complaints as well as for general representation. I should have hoped that these new neighbourhood health councils would have greater power to investigate complaints. The odd letter sent to the health authority or the family practitioners' council would not be sufficient. They should have the right to investigate to find whether a complaint was genuine and could be sustained and to have it rehearsed in detail. It is not satisfactory to leave the solution of such complaints to a health commissioner who is more of a eunuch because he is so restricted in what he can investigate. It would be far better for the individual complaint against the service provided by the GP or the hospital authority to be dealt with by the neighbourhood health council which I hope will cover the health authorities as a whole. This could be more effectively dealt with through elected groups.
This new clause is important because without it nothing in the Bill will ensure that there is an administrative system by which the voice of the people and of the patients can be heard and understood. The whole organisation pattern in the Bill is designed to do the direct opposite. The Bill is designed to muffle the voice of the public and to ensure that the patient is kept at arm's length. This is a conspiracy to keep the patient and the public away from decision making. Neighbourhood health councils of this kind are essential for the healthy democracy which we believe is an intrinsic part of the health service, as of every other aspect of community life.

Mr. Caerwyn Roderick: It is important to establish bodies in this sphere which will be independent of the area health authorities, of the Minister, and the regional health authorities. The AHAs and the RHAs are not independent of the Minister because appointments are made by the Secretary of State. I want to see someone at some level directly representing the consumer. Elected bodies should be used for this purpose whether they are elected specially to look after health matters or have several duties.
In Wales we could use the new county councils or district councils. They should

be the "watchdogs", looking after the interests of the public and prepared to argue with the Minister and area health authorities and to represent the public at all stages. They should be able to speak frankly to all who are involved in the service. Such a council should not be housed in AHA premises. It should be quite independent of the area health authorities and not staffed by area health authority staff.
The public must see that the councils are completely free to act as they wish. They must not be seen to be subject to pressures from within. If the same staff and premises are used they will not be seen to be independent. So often in Committee the Minister rested his case on "He who pays the piper calls the tune." No one will deny that in the end the Secretary of State will have the power to overrule decisions taken below. This happens in so many spheres of activity. But the Secretary of State will need to have a good case to do this. It will be no excuse for him to reply that he must be in full control at every level.
The Bill establishes community health councils, to be co-terminous with districts and the districts are to be as defined in the Bill, not local government districts. I am being a little parochial here, but it is relevant. Until now the district defined for the area I come from has been a district of over 2,000 sq. miles, Powys, in Mid-Wales. How can a watchdog body be set up for such a large area? No decision has yet been taken to split that area. This new clause suggests that there should be at least three neighbourhood councils for such a large area, based on the district authorities of local government. If that were done there would be a far better chance of knowing what was going on from day to day in the Health Service.
I would break it down even further and go to the new community health councils as the watchdogs. Then we will certainly have day-to-day contact. I deplore the present situation when so many parts of the country will suffer because community health councils will be meaningless on such a large scale.

Mr. Gibson-Watt: Did the hon. Gentleman make a slip of the tongue when he said "community health council"? I think he meant "community council".

Mr. Roderick: Yes, I did mean community council. They are mentioned in the Bill and are quite different bodies from community health councils. I would not quarrel with the community council being used as a vehicle for our aims. I certainly would not quarrel with the idea of using the new district local authorities as that vehicle. I embrace the point made by my hon. Friend the Member for South Shields (Mr. Blenkinsop), who suggested that people working in the health service should be represented.
There would be no difficulty in co-opting members as we do at present, with education committees, for example. We co-opt teachers and others working in the service and we could easily do it in this case. I hope that the Minister will be able to accept this clause. It will be a matter of two years at the most before it can be implemented. He may as well take this little step along the road. The Government have adopted so many of our ideas in the last couple of years that they certainly cannot object to adopting this useful one.

Mr. Pavitt: My hon. Friend the Member for Merthyr Tydfil (Mr. Rowlands) outlined the principle underlying this new clause and a good deal of the debate we have had about the whole of the Bill when he referred to the patients as being ancillary props against the background of the professionals, the doctors and so on, exemplified in the television "soap operas" when the patients are part of the scene rather than anything to do with the story.
I want to introduce a little fresh evidence on this subject from a rather unusual source. A strong plea was made by the clerk to the governors at one of the London teaching hospitals—a hospital considered to be one of the finest and certainly one of the most important in the country. This is from a person who has been working with an administrative machine. What is happening—and the clause seeks to remedy it—is that as a result of the obsession with the managerial machine and the efforts to secure efficiency, the impact of reorganisation on the people is being wiped out.
There is no better way of reversing this than by adopting the clause. We are seeking to bring the service and its administration under the control of

people who are in physical and geographical proximity to it. These are the people who know their own general practioners and their own hospitals. The community health council area will cover 200,000 to 250,000 people. If we could start to reach down to a neighbourhood unit about the size of a London borough ward—say, 10,000 to 20,000 people—we would be talking in terms of practical experience, about a particular general practitioner, immunisation service, antenatal clinic.
6.45 p.m.
What the clerk to the governors puts most strongly is that the managerial concept being put forward by the Government is the basic building block for all the district. That will be governed by a district management team of six people, who will be entirely outwith any control except that of the area authority. If the real power is to rest at district level the proposition of the neighbourhood unit is one of the most essential checks and balances. It will be interesting to hear in the Minister's reply why he under-values nurses on the district management team of six. They receive £1,000 a year less than the administrators serving on the same area health management team. That is a considerable amount. I do not know why it is that nurses are always reckoned to be cheap labour. On that team of six the area nursing officer will get much less than any other members of the team.
A large London area with five or six districts is likely to have a budget of between £40 million and £50 million, and to employ between 20,000 and 30,000 people. That kind of organisation should not be divorced from the people it is serving. There must be some system whereby the voice of the people can be heard, whereby they can make some impact and bring about change if necessary. They must be able to place pressure on a machine that has been described by the newspapers as a bureaucratic monster, entirely geared to the idea that what is good for industry is good for the National Health Service.
In opening the debate on Second Reading my right hon. Friend the Member for Deptford (Mr. John Silkin) spoke about shedding tiers, because the five-tier structure was too large. It is interesting to note that the clerk to the governors,


whom I have mentioned, says that responsibility at the level of district must have public participating support and that it would be far better for one of the two higher levels, possibly the regional level, to be disposed of to make room for the neighbourhood councils. I hope that the House will support the clause.

Mr. Gibson-Watt: I shall endeavour to reply to most of the points that have been raised, but if I do not satisfy the inquiries of all those who have spoken I hope that I shall be forgiven. I intend to aim specifically at what has been my particular responsibility for the past three years—the hospitals and the health services of Wales.
We would certainly all endorse the basic aim that the patients and the communities for which the National Health Service exists shall have effective means of influencing its planning and operation. I am bound to advise that the new clause, however well intentioned, is not well calculated to advance this common purpose. The House will probably agree that to be effective the bodies set up to represent the interests of the people as patients—or consumers, as some hon. Members have described them—must have a common interest in the health service. It is often true that the smaller the community of people the closer is the general community of interests in all aspects of life. This is, perhaps, particularly true of small rural communities, and it is certainly true of some of our valley communities in Wales. There is a sense of belonging and a sense of shared problems and shared purposes, which is both admirable and enviable.
However, there is a basic dilemma here, because bodies designed to bring a real influence on all aspects of running and planning the health service must be conceived on a pattern which has a meaningful relationship to the way in which the health service itself is organised. They must be sufficiently broadly based to recognise the competing calls on health service resources and to be able to make informed judgments on what the priorities should be so that their representations will deserve and command the respect and attention of the area health authorities. What I am saying is that those who are going to make the inquiries

and those who will complain must themselves be armed with some expertise if they are to be able to stand up to and argue with the area health authorities. Indeed, we believe they would lose much of their force and effect if they were to be a multiplicity of small bodies as the new clause suggests.
In general, the Government believe that the best pattern will normally be for the community interest to be focused through a community health council coterminous with a health district, which is the administrative unit on which much of the health planning will be based and in which the district management team will exercise a large measure of delegated responsibility for running the various services. These are the smallest units in which a reasonably comprehensive range of health services can be provided and the smallest practicable units for integrated management of the health service. Indeed, a community health council matching such a health district will normally represent the smallest true denominator of the community interest over the whole range of the health service and will be in the best position to take a balanced view and to speak effectively to the district management team on all the day-to-day problems as well as to the area health authority in matters where it cannot get satisfaction at this more local level.
We recognise that there is need for some flexibility in the pattern of community health councils.
The hon. Member for Brecon and Radnor (Mr. Roderick) referred to this problem in his own constituency, which I know well. I assure him that my right hon. and learned Friend is very ready to accept that some flexibility of pattern in Powys and Gwynedd, with their wide areas and scattered populations, and where health administration cannot meaningfully be broken down into districts, is very necessary. When, in Committee, we were examining the provisions for community health councils, my hon. Friend the Under-Secretary suggested that one possibility in such an area as that might be one community health council with a larger membership than usual, with groups of members having a special concern for particular localities and, perhaps, coming together as sub-committees of the main council.
Some Opposition Members have said that they do not believe that this would be a satisfactory way out. If that proves to be the considered view of the communities and interests most directly concerned my right hon. and learned Friend, who intends to consult the relevant local authority and other interests in each area before making any decisions, would not wish to force this solution on them. He is more than prepared to consider flexibility in this respect. He would be quite ready to consider setting up two or more community health councils in Powys and, indeed, Gwynedd. He has commended a proposal in the Welsh "Red Book" that in order to achieve as much local delegation of health administration as is practicable in these circumstances both these areas might be managed through a number of geographical divisions—something less than a health district in the comprehensiveness of resources and functions—and there might usefully be a community health council for each such geographical division.
The neighbourhood health councils which the proposed new clause contemplates would, in our opinion, be far too small to be effective. For example, my right hon. Friend might find himself required to set one up for the present parish of Pennant in the rural district of Llanfyllin in north Montgomeryshire, or the present parish of Isygarreg in the rural district of Machynlleth in west Montgomeryshire, each with a population of less than 200 people. He might be required, with no option to refuse, to set up 10 neighbourhood health councils in the Gower. I do not honestly believe that hon. Members would like to see that. Potentially, this could mean 760 neighbourhood councils of this sort in Wales. Coming back to the English pattern for a moment, if this proposal were carried through over Offa's Dyke and applied in England there might be around 10,000.
I am perfectly prepared to accept that this new clause is a probing amendment. I accept that. The speeches which have been forcefully made in this debate have, I hope, elicited reasons why the Government think the best answer in all the circumstances lies in the proposals we have put forward in the Bill. Therefore, I would propose to the Opposition that they should not pursue this new clause

tonight, and I would certainly hope they would not pursue it to the point of a vote upon it.

Mr. John Silkin: Running through the whole of the Opposition case, as first put by my hon. Friend the Member for South Shields (Mr. Blenkinsop), and later by all my hon. Friends, from slightly different standpoints, has been dissatisfaction with the proposed reorganisation of the National Health Service on a managerial basis. I suspect that the Minister of State sees perfectly clearly that there are difficulties about it. Indeed. I thought he went out of his way to be very conciliatory and to accept that there is a dilemma in which he and his hon. and right hon. Friends have been placed. This is the question of responsibility of management, and so on. To come to what he thinks is the best solution, I think that most of what he said, if not all, was perfectly applicable to the United Kingdom as a whole—certainly to England—as well as to Wales. I thought he made the best case he could. We, on our side, do not apologise for having strayed across Offa's Dyke, because this Bill does it frequently, as does the Local Government Act.
The Government have proposed to the House and the nation a reorganisation of the National Health Service based on a managerial and what I have called a monarchical principle. This has been the whole basis of it, and the Government themselves, understandably—and, perhaps, commendably, once one accepts the first wrong assumption—have said that they want to introduce, somewhere, an element of accountability to the public; that they agree that the organisation is too rigid, too monarchical, and too tyrannical, and that somewhere the public must be represented. The Government have, in consequence, looked all along the various stages of the monolithic system and have evolved a system at district level called the community health council, and it is that council which is given the function of barking—of acting as a watchdog and saying where management has gone wrong.
7.0 p.m.
The community health council operates for the same unit or area as does the district management team, which is a managerial unit composed of doctors,


one nurse, and administrative workers. It is because this district management team is accountable to no democratic element that the community health council has been injected. In a properly-run National Health Service the community health council would be democratically elected and would operate the health service in the district. The district management team would be its experts and officials, and the community health council would inevitably have to be guided by what they said. The final decision, however, would be made by people who are responsible to the electorate.
The politician gets a lot of kicks—sometimes from himself. In these days he is considered to be out of touch with the public. Nevertheless, it is the politician who has to justify his policies, to make them, to be responsible for them, and never to be ashamed of them, and he must allow the electorate to say whether they think he is right. That is the function of all hon. and right hon. Members, and it is the function of every councillor.
The administration of a health service is no different from the administration of a local council, this House, or Government. It concerns a vital function, which affects every man, woman and child in this country. Because the managerial concept took possession of the Department of Health and Social Security and successive Secretaries of State, we are landed with a system that has no democratic accountability in it.
The object of the clause is to introduce a degree of democratic accountability somewhere. It is not a very great stride forward. It produces a neighbourhood health council. My hon. Friend the Member for Merthyr Tydvil (Mr. Rowlands) said that he would like it to have far greater powers, but one realises that at this moment it cannot. What it can have is the right to say in such an area, however small it may be, "We think things are going wrong and something should be done about it."
The Minister of State has got hold of the wrong end of the stick. May I give him a small lecture in democracy? Democracy consists of voters—ordinary men and women, our fellow-citizens, who have no informed judgment, who are not armed with expertise but who are the

people who live in our country and for whose happiness we are supposed to be legislating. The very fact that they do not have this informed knowledge or expertise is their strength. They are the people who have to put up with things. They are the people who should be given a chance to express their feelings of disapprobation when they feel that something is going wrong—a grumble perhaps, but a pressurised grumble. They are the people who have to complain about how long they have to wait in hospital, and many other things that fall within a tiny local area. The strength of the neighbourhood health council is that it is not informed and that it has a right to grumble. It is then up to those who administer the health service to deal with that grumble.
I am not frightened of 10,000 neighbourhood councils, but I do not think that there would be anywhere near that number—that is perhaps a pity. I am not even frightened of the 760 in the Principality, but I am afraid that it would not be anywhere near that number. Only in a few wide-awake districts would an application be made to the Secretary of State for the creation of a neighbourhood health council. Judging by what the Minister of State said, in no case would a Conservative Secretary of State for Social Services or Secretary of State for Wales set one up on his own accord. So we know how many there would be. At least there would be this addition to a managerial, purely administrative, purely Whitehall-run health service. Somewhere, ordinary people would feel that there was some institution elected by themselves that was listening to their complaints. That is the purpose of the neighbourhood health council.
The Minister of State heard arguments about the Principality and about England in the long nights and days of the passage of the Local Government Bill in Committee and on Report. The same basis applied there. I have said that the neighbourhood health council owes its proposed existence to the fact that the health service is not a democratic institution. If it became a democratic institution under local government control, as mangy of us hope it will one day, the neighbourhood health council would merge simply and easily with the parish council or the community council. It would simply


become an arm of it—an elected body at local level which would have its say and be able to make its point in the running of the health service. I have spoken about the ordinary people. At least once in their lives, either at the beginning or at the end—and sometimes in between—they are patients as well as voters.
There is another body that is totally neglected. Under successive Governments and successive Ministers of Health of whatever party there has been the great omission of the health service workers. Labour Governments were as guilty of this as were Conservative Governments. It is a factor that should have been understood but was not.
My hon. Friend the Member for Huddersfield, West (Mr. Lomas), by slightly bending the rules of order, made a telling intervention. He argued that the health service ancillary workers have been particularly neglected in the running of the health service. He supported the idea of the neighbourhood health council because it could include in it the health service workers whose voice could be listened to there. We have all neglected the health service workers, and we paid the penalty for it earlier this year. All those who are engaged in or interested in the health service know how devoted was the service of these workers and how successive Governments have relied too much on their good will and devotion to the public in the running of the hospital service. They have much more to contribute. We have also neglected their expertise, which is extremely valuable.
We do not consider this clause to be just a probing clause. Its purpose is to inject an element of democracy into the health service. My hon. Friend the Member for Brecon and Radnor (Mr. Roderick) showed us how ludicrous might be a "community" under the community health council. The Minister of State did not give a universal reply to that. What might be true in one case would not necessarily be true in others. I am not suggesting that my hon. Friends should treat this merely as a probing clause. They should show by their votes in the Lobby that it is a constructive improvement to a badly reorganised health service.

Mr. Gibson-Watt: With the leave of the House, may I, having had a lecture on democracy from the right hon. Member for Deptford (Mr. John Silkin), be allowed to reply. I thought I had given my own Member of Parliament, the hon. Member for Brecon and Radnor Mr. Roderick), a general answer on the problems of Powys. I assure him that my right hon. and learned Friend the Secretary of State for Wales will take carefully into consideration the problems of Powys. If it requires two councils, as I understand it may do, it will get two from the Welsh Office.

Mr. Rowlands: rose——

Mr. Gibson-Watt: The hon. Member has already made an extreme speech, more extreme than usual, and I remind him that one cannot run a health service without doctors.
If the right hon. Member for Deptford wants this many neighbourhood councils, there is nothing to stop them being set up. There is nothing to stop an area of the size of a parish council deciding that it cares so much about the hospitals in its area that it should have its own organisation. But in the Bill we are setting up by statute organisations which can argue on proper professional advice against the area health authority. There, with respect, lies the fallacy of the right hon. Gentleman's argument. I remember that at one time a hospital near my home was about to be closed by the Labour Government. A body was set up to consider the matter, and, although it had no professional advice, it operated skilfully and adequately. But it was not thought necessary to prescribe that in a statute.
The hon. Member for Huddersfield, West (Mr. Lomas) asked about NUPE. The set-up of the district health council will be as follows. There will be 50 per cent. members appointed by the county councils and the district councils. One-third of the members will be made up of members of voluntary bodies concerned with health matters; the final sixth will be provided by voluntary bodies not specifically concerned with health. I hope that what I have said will go a long way to meet the hon. Gentleman's points.

Mr. Lomas: I accept entirely what the Minister says but I believe that it does not go far enough. Both my union and I say that the trade unions and workers


in the National Health Service should be represented on the district councils and others as of right, and should not just come together in some other way.

Mr. Gibson-Watt: I see the hon. Gentleman's point. If I cannot go all the way

to help him, I hope that what I have said will give him some assurance on the points he raised.

Question put:—

The House divided: Ayes 245, Noes 271.

Division No. 148.]
AYES
[7.15 p.m.


Abse, Leo
Fletcher, Raymond (Ilkeston)
Mackenzie, Gregor


Allaun, Frank (Salford, E.)
Fletcher, Ted (Darlington)
Mackie, John


Archer, Peter (Rowley Regis)
Foot, Michael
Mackintosh, John P.


Ashley, Jack
Ford, Ben
Maclennan, Robert


Ashton, Joe
Forrester John
McMillan, Tom (Glasgow, C.)


Atkinson, Norman
Fraser, John (Norwood)
McNamara, J. Kevin


Bagier, Gordon A. T.
Freeson, Reginald
Mahon, Simon (Bootle)


Barnes, Michael
Galpern, Sir Myer
Mallalieu, J. P. W. (Huddersfield, E.)


Barnett, Joel (Heywood and Royton)
Garrett, W. E.
Marquand, David


Baxter, William
Gilbert, Dr. John
Marsden, F.


Beaney, Alan
Ginsburg, David (Dewsbury)
Mason, Rt. Hn. Roy


Bennett, James(Glasgow, Bridgeton)
Golding, John
Mayhew, Christopher


Bidwell, Sydney
Gordon Walker, Rt. Hn. P. C.
Meacher, Michael


Bishop E. S.
Gourlay, Harry
Mellish, Rt. Hn. Robert


Blenkinsop, Arthur
Grant, George (Morpeth)
Wendelson, John


Boardman, H. (Leigh)
Grant, John D. (Islington, E.)
Mikardo, Ian



Griffiths, Eddie (Brightside)



Booth, Albert
Hamilton, James (Bothwell)
Millan, Bruce


Boothroyd, Miss B. (West Brom.)
Hamilton, William (Fife, W.)
Miller, Dr. M. S.


Bottomley, Rt. Hn. Arthur
Hamling, William
Milne, Edward


Boyden, James (Bishop Auckland)
Hannan, William (G'gow, Maryhill)
Mitechell, R.C. (S'hampton, Itchen)


Broughton, Sir Alfred
Hardy Peter
Molloy, William


Brown, Hugh D. (G'gow, Proven)
Harper, Joseph
Morgan, Elystan (Cardiganshire)


Buchan, Norman
Harrison Walter (Wakefield)
Morris, Alfred (Wythenshawe)


Buchanan, Richard (G'gow, Sp'burn)
Hart, Rt. Hn. Judith
Morris, Charles R. (Openshaw)


Butler, Mrs. Joyce (Wood Green)
Hattersley, Roy
Morris, Rt. Hn. John (Aberavon)


Callaghan, Rt. Hn. James
Healey, Rt. Hn. Denis
Moyle, Roland


Campbell, I. (Dunbartonshire, W.)
Heffer, Eric S.
Murray, Ronald King


Cant, R. E
Horam John
Oakes, Gordon


Carter, Ray (Birmingh'm, Northfield)
Houghton, Rt. Hn. Douglas
Ogden, Eric


Castle, Rt. Hn. Barbara
Howell, Denis (Small Heath)
O'Halloran, Michael


Clark, David (Colne Valley)
Huckfield, Leslie
O'Malley, Brian


Cocks, Michael (Bristol, S.)
Hughes, Rt. Hn. Cledwyn (Anglesey)
Oram, Bert


Cohen, Stanley
Hughes, Mark (Durham)
Orbach, Maurice


Coleman, Donald
Hughes, Robert (Aberdeen, N.)
Orme, Stanley


Concannon, J. D.
Hughes, Roy (Newport)
Oswald, Thomas


Corbet, Mrs. Freda
Irvine, Rt. Hn. Sir Arthur (Edge Hill)
Padley, Walter


Cox, Thomas (Wandsworth, C.)
Janner, Greville
Paget, R. T.


Crawshaw, Richard
Jay, Rt. Hn. Douglas
Palmer, Arthur


Cronin, John
Jeger, Mrs. Lena
Pannell, Rt. Hn. Charles


Crosland, Rt. Hn. Anthony
Jenkins, Hugh (Putney)
Parker, John (Dagenham)


Crossman, Rt. Hn. Richard
John, Brynmor
Parry, Robert (Liverpool, Exchange)


Cunningham, Dr. J. A. (Whitehaven)
Johnson, Carol (Lewisham, S.)
Pavitt, Laurie


Dalyell, Tam
Johnson, James (K'ston-on-Hull, W.)
Peart, Rt. Hn. Fred


Davidson, Arthur
Johnson, Walter (Derby, S.)
Perry, Ernest G.


Davies, Denzil (Lianelly)
Johnston, Russell (Inverness)
Prentice, Rt. Hn. Reg.


Davies, G. Elfed (Rhondda, E.)
Jones, Barry (Flint, E.)
Prescott, John


Davies, Ifor (Gower)
Jones, Dan (Burnley)
Price, William (Rugby)


Davis, Clinton (Hackney, C.)
Jones, Gwynoro (Carmarthen)
Probert, Arthur


Davis, Terry (Bromsgrove)
Jones, T. Alec (Rhondda, W.)
Radice, Giles


Deakins, Eric
Kaufman, Gerald
Rankin, John


de Freitas, Rt. Hn. Sir Geoffrey
Kelley, Richard
Reed, D. (Sedgefield)


Delargy, Hugh
Lambie, David
Rees, Merlyn (Leeds, S.)


Dell, Rt. Hn. Edmund
Lamborn, Harry
Rhodes, Geoffrey


Dempsey, James
Lamond, James
Roberts, Albert (Normanton)


Doig, Peter
Latham, Arthur
Roberts, Rt.Hn.Goronwy(Caernarvon)


Dormand, J. D
Lawson, George
Robertson, John (Paisley)


Douglas, Dick (Stirlingshire, E.)
Lea, Rt. Hn. Frederick
Roderick, Caerwyn E.(Brc'n&amp;R'dnor)


Douglas-Mann, Bruce
Leonard, Dick
Rodgers, William (Stockton-on-Tees)


Driberg, Tom
Lewis, Arthur (W. Ham, N.)
Roper, John


Duffy, A. E. P.
Lewis, Ron (Carlisle)
Rose, Paul B.


Dunnett, Jack
Lipton, Marcus
Ross, Rt. Hn. William (Kilmarnock)


Edelman, Maurice
Lomas, Kenneth
Rowlands, Ted


Edwards, Robert (Bilston)
Loughlin, Charles
Sandelson, Neville


Edwards, William (Merioneth)
Lyon, Alexander W. (York)
Sheldon, Robert (Ashton-under-Lyne)


Ellis, Tom
Lyons, Edward (Bradford, E.)
Shore, Rt. Hn. Peter (Stepney)


English, Michael
McBride, Neil
Short, Mrs. Renée (W'hampton,N.E.)


Evans, Fred
McCartney, Hugh
Silkin, Rt. Hn. John (Deptford)


Ewing, Harry
McElhone, Frank
Silkin, Hn. S. C. (Dulwich)


Fernyhough, Rt. Hn. E.
McGuire, Michael
Sillars, James


Fisher, Mrs. Doris (B'ham,Ladywood)
Machin, George
Skinner, Dennis




Small, William
Tinn, James
Wells, William (Walsall, N.)


Smith, John (Lanarkshire, N.)
Tomney, Frank
White, James (Glasgow, Pollok)


Spearing, Nigel
Tope, Graham
Whitehead, Phillip


Spriggs, Leslie
Torney, Tom
Whitlock, William


Stallard, A. W.
Tuck, Raphael
Williams, Alan (Swansea, W.)


Steel, David
Varley, Eric G.
Williams, Mrs. Shirley (Hitchin)


Stewart, Rt. Hn. Michael (Fulham)
Wainwright, Edwin
Williams, W. T. (Warrington)


Stoddart, David (Swindon)
Walden, Brian (B'm'ham, All Saints)
Woof, Robert


Stonehouse, Rt. Hn. John
Walker, Harold (Doncaster)



Strauss, Rt. Hn. G. R.
Wallace, George
TELLERS FOR THE AYES:


Summerskill, Hn. Dr. Shirley
Watkins, David
Mr. Ernest Armstrong and Mr. James A. Dunn.


Swain, Thomas
Weitzman, David



Thomas, Jeffrey (Abertillery)
Wellbeloved, James





NOES


Adley, Robert
Farr, John
Lamont, Norman


Alison, Michael (Barkston Ash)
Fanner, Mrs. Peggy
Lane, David


Allason, James (Hemel Hempstead)
Fidler, Michael
Langford-Holt, Sir John


Amery, Rt. Hn. Julian
Finsberg, Geoffrey (Hampstead)
Le Merchant, Spencer


Archer, Jeffrey (Louth)
Fisher, Nigel (Surbiton)
Lewis, Kenneth (Rutland)


Astor, John
Fookes, Miss Janet
Lloyd, Rt.Hn.Geoffrey(Sut'nC'field)


Atkins, Humphrey
Fortescue, Tim
Lloyd, Ian (P'tsm'th, Langstone)


Awdry, Daniel
Foster, Sir John
Loveridge, John


Baker, Kenneth (St. Marylebone)
Fowler, Norman
McAdden, Sir Stephen


Baker, W. H. K. (Banff)
Fox, Marcus
MacArthur, Ian


Balniel, Rt. Hn. Lord
Fraser,Rt.Hn.Hugh(St'fford &amp; Stone)
McCrindle, R. A.


Batsford, Brian
Galbraith, Hn. T. G. D.
McLaren, Martin


Beamish, Col. Sir Tufton
Gardner, Edward
Maclean, Sir Fitzroy


Bell, Ronald
Gibson-Watt, David
McMaster, Stanley


Bennett, Sir Frederic (Torquay)
Gilmour, Ian (Norfolk, C.)
Macmillan, Rt.Hn.Maurice(Farnham)


Bennett, Dr. Reginald (Gosport)
Glyn, Dr. Alan
McNair-Wilson, Michael


Benyon, W.
Godber, Rt. Hn. J. B.
McNair-Wilson, Patrick (New Forest)


Berry, Hn. Anthony
Goodhart, Philip
Maddan, Martin


Biffen, John
Gower, Raymond
Madel, David


Biggs-Davison, John
Grant, Anthony (Harrow, C.)
Marples, Rt. Hn. Ernest


Boardman, Tom (Leicester, S.W.)
Gray, Hamish
Marten, Neil


Body, Richard
Green, Alan
Mather, Carol


Boscawen, Hn. Robert
Grieve, Percy
Maude, Angus


Bowden, Andrew
Grylls, Michael
Maudling, Rt. Hn. Reginald


Braine, Sir Bernard
Gummer, J. Selwyn
Mawby, Ray


Bray, Ronald
Gurden, Harold
Maxwell-Hyslop, R. J.


Brown, Sir Edward (Bath)
Hall, Miss Joan (Keighley)
Meyer, Sir Anthony


Bruce-Gardyne, J.
Hall, John (Wycombe)
Mills, Peter (Torrington)


Bryan, Sir Paul
Hall-Davis, A. G. F.
Miscampbell, Norman


Buchanan-Smith, Alick(Angus,N&amp;M)
Hamilton, Michael (Salisbury)
Mitchell, David (Basingstoke)


Buck, Antony
Hannam, John (Exeter)
Moate, Roger


Bullus, Sir Eric
Harrison, Brian (Maldon)
Monks, Mrs. Connie


Burden, F. A.
Harrison, Col. Sir Harwood (Eye)
Monro, Hector


Butler, Adam (Bosworth)
Haselhurst, Alan
More, Jasper


Campbell, Rt.Hn.G. (Moray &amp; Nairn)
Hastings, Stephen
Morgan-Giles, Rear-Adm.


Carlisle, Mark
Havers, Michael
Mudd, David


Carr, Rt. Hn. Robert
Heseltine, Michael
Murton, Oscar


Channon, Paul
Hicks, Robert
Nabarro, Sir Gerald


Chapman, Sydney
Higgins, Terence L.
Neave, Airey


Chataway, Rt. Hn. Christopher
Hiley, Joseph
Nicholls, Sir Harmar


Chichester-Clark, R.
Hill, John E. B. (Norfolk, S.)
Noble, Rt. Hn. Michael


Clark, William (Surrey, E.)
Hill, James (Southampton, Test)
Normanton, Tom


Clegg, Walter
Holland, Philip
Nott, John


Cockeram, Eric
Holt, Miss Mary
Onslow, Cranley


Cooke, Robert
Hordern, Peter
Oppenheim, Mrs. Sally


Coombs, Derek
Hornby, Richard
Orr, Capt. L. P. S.


Cooper, A. E.
Hornsby-Smith Rt.Hn.Dame Patricia
Page, Rt. Hn. Graham (Crosby)


Cordle, John
Howe, Hn. Sir Geoffrey (Reigate)
Parkinson, Cecil


Corfield, Rt. Hn. Sir Frederick
Howell, David (Guildford)
Percival, Ian


Cormack, Patrick
Howell, Ralph (Norfolk, N.)
Pike, Miss Mervyn


Costain, A. P.
Hunt, John
Pink, R. Bonner


Critchley, Julian
Hutchison, Michael Clark
Pounder, Rafton


Crouch, David
Iremonger, T. L.
Powell, Rt. Hn. J. Enoch


d'Avigdor-Goldsmid, Sir Henry
Irvine, Bryant Godman (Rye)
Price, David (Eastleigh)


d'Avigdor-Goldsmid,Maj.-Gen.Jack
James, David
Proudfoot, Wilfred


Dean, Paul
Jenkin, Patrick (Woodford)
Pym, Rt. Hn. Francis


Digby, Simon Wingfield
Jessel, Toby
Quennell, Miss J. M.


Dixon, Piers
Johnson Smith, G. (E. Grinstead)
Raison, Timothy


Dodds-Parker, Douglas
Jones, Arthur (Northants, S.)
Ramsden, Rt. Hn. James


Drayson, G. B.
Jopling, Michael
Rawlinson, Rt. Hn. Sir Peter


du Cann, Rt. Hn. Edward
Joseph, Rt. Hn. Sir Keith
Redmond, Robert


Dykes, Hugh
Kaberry, Sir Donald
Reed, Laurance (Bolton, E.)


Eden, Rt. Hn. Sir John
Kimball, Marcus
Rees, Peter (Dover)


Edwards, Nicholas (Pembroke)
King, Evelyn (Dorset, S.)
Rees-Davies, W. R.


Elliot, Capt. Walter (Carshalton)
Kirk, Peter
Renton, Rt. Hn. Sir David


Elliott, R. W. (N'c'tle-upon-Tyne,N.)
Kitson, Timothy
Rhys Williams, Sir Brandon


Emery, Paler
Knight, Mrs. Jill
Ridley, Hn. Nicholas


Eyre, Reginald
Knox, David
Rippon, Rt. Hn. Geoffrey







Rodgers, Sir John (Sevenoaks)
Stokes, John
Walker, Rt. Hn. Peter (Worcester)


Rossi, Hugh (Hornsey)
Stuttaford, Dr. Tom
Walker-Smith, Rt. Hn. Sir Derek


Rost, Peter
Sutcliffe, John
Wall, Patrick


Royle, Anthony
Tapsell, Peter
Walters, Dennis


Russell, Sir Ronald
Taylor, Sir Charles (Eastbourne)
Ward, Dame Irene


St. John-Stevas, Norman
Taylor,Edward M. (G'gow,Cathcart)
Warren, Kenneth


Sandys, Rt. Hn. D.
Taylor, Frank (Moss Side)
Weatherill, Bernard


Scott, Nicholas
Taylor, Robert (Croydon, N.W.)
Wells, John (Maidstone)


Scott-Hopkins, James
Tebbit, Norman
Wiggin, Jerry


Shaw, Michael (Sc'b'gh &amp; Whitby)
Temple, John M.
Wilkinson, John


Shelton, William (Clapham)
Thatcher, Rt. Hn. Mrs. Margaret
Winterton, Nicholas


Simeons, Charles
Thomas, John Stradling (Monmouth)
Wolrige-Gordon, Patrick


Sinclair, Sir George
Thomas, Rt. Hn. Peter (Hendon, S.)
Wood, Rt. Hn. Richard


Skeet, T. H. H.
Thompson, Sir Richard (Croydon, S.)
Woodhouse, Hn. Christopher


Smith, Dudley (W'wick &amp; L'mington)
Tilney, John
Woodnutt, Mark


Soref, Harold
Trafford, Dr. Anthony
Worsley, Marcus


Speed, Keith
Trew, Peter
Wylie, Rt. Hn. N. R.


Spence, John
Tugendhat, Christopher



Sproat, Iain
Turton, Rt. Hn. Sir Robin
TELLERS FOR THE NOES:


Stainton, Keith
van Straubenzee, W. R.
Mr. Kenneth Clarke and Mr. Paul Hawkins


Stanbrook, Ivor
Vaughan, Dr. Gerard



Stewart-Smith, Geoffrey (Belper)
Vickers, Dame Joan



Stodart, Anthony (Edinburgh, W.)
Waddington, David

Question accordingly negatived.

New Clause 4

ASSISTANCE FOR PARENTS OF CHILDREN IN HOSPITAL

It shall be the duty of the Secretary of State to provide for the provision of accommodation and other facilities, including financial assistance, for parents of children in hospital; and the Secretary of State may make regulations regarding the nature, mode and scale of such facilities and assistance.—[Dr. Summenkill.]

Brought up, and read the First time.

Dr. Shirley Summerskill: I beg to move, That the clause be read a Second time.

Mr. Deputy-Speaker (Sir Robert Grant-Ferris): With this clause it will be convenient to discuss new Clause 5—[Reimbursement of travelling expenses of patients' visitors].

Dr. Summerskill: New Clause 4 covers a smaller category of people than new Clause 5, but it extends the help required.
The Committee debate on the subject covered by new Clause 4 was most instructive and constructive, yet the Opposition were not at all satisfied with the Government's reply.
The peculiar and special difficulties faced by parents when children are in hospital have given rise to the clause. There must be few hon. Members who have not had personal experience of these difficulties or have not received complaints from constituents.
Public opinion about it is being co-ordinated by the extensive activities and

enterprise of the National Association for the Welfare of Children in Hospital. This consists not only of parents but of doctors, nurses, medical social workers and health visitors. The association is expanding rapidly, and it is now generally accepted that parents can play a vitally important part in the promotion of the recovery of their children, in improving their morale, in avoiding psychological trauma as a result of admission to hospital, and in learning about the aftercare of their children when they return home.
An inquiry was carried out recently by the National Association for the Welfare of Children in Hospital and a survey was made of specialist and children's hospitals which showed that 19 per cent. of children came from homes more than 20 miles away from the hospitals and that 7 per cent. came from more than 50 miles away. An inquiry over a period of 20 weeks by a medical social worker at a large orthopaedic hospital revealed that during this period eight out of 34 parents incurred travelling expenses of between £100 and £200 each.
The recommendations that we are making, therefore, are based not only on statistics of this kind but historically upon the conclusions of the very famous Platt report which was published as long ago as 1959 but of which there is general agreement on both sides of the House that there should be some implementation.
The existing provision of finances for travelling is varied and not at all satisfactory. The social security system makes an allowance to parents already receiving supplementary benefit if they


can show cause and, in rare cases, assists people who are receiving very low wages. There are some local authorities which will give assistance on the recommendations of health visitors and social workers, but again this varies widely. There are some sick children's charities and leagues of friends which will assist in certain cases, but policies vary from hospital to hospital and branch to branch. Some hospitals allow their own welfare funds to be used. But the present system obviously is most unsatisfactory and unfair in many respects.
7.30 p.m.
Accommodation in hospitals is the main provision in the clause. Accommodation, as we established in Committee, is basically accommodation overnight for one or other of the parents. From this would follow waiting rooms during the day, rest rooms and canteen facilities. But the point to establish primarily is overnight accommodation. There is slow improvement, but improvement nevertheless, in the provision of this accommodation.
I should like to draw attention to the figures for the Leeds hospital region which serves the constituencies of the Secretary of State the right hon. Member for Leeds, North-East (Sir K. Joseph) and the Under-Secretary of State the hon. Member for Barkston Ash (Mr. Alison). In February 1972 only 32 per cent. of hospitals in that region could offer beds to mothers and, if necessary, fathers. So there is great variation in the provision of accommodation in this sphere. Yet nursing staff are learning to care for children more as family units. Everyone now accepts that parents have an important rôle to play in the care of sick children.
The provision of travelling expenses is a discretionary power of local authorities, but there is an increasing need for help in this respect. Bus and train fares are for ever rising. Hospitals are becoming increasingly centralised and away from the local community, so that people living in rural areas often spend hours travelling to get to their children. There are specialist hospitals where a child may be forced to remain because it is suffering from a particular complaint, is a long-stay patient, or has sustained an

accident in a particular area. Therefore, it is an increasingly practical problem, or an impossibility, for some parents to visit their children.
Professor Oppe, a paediatric adviser to the Department of Health and Social Security, at a recent conference of the National Association for the Welfare of Children in Hospital said:
Fares assistance should not be considered as a hand-out on compassionate grounds, but part of the medical care of children and the medical care of families.
I have had drawn to my attention the case of a father and mother in Leeds whose six-year-old son has been in hospital in Berkshire for many months. They were told by the medical social worker, who had no more money to give them, that they should restrict their visits to one a month. It costs those parents over £10 a visit.
We propose new Clause 4 as, a start in this matter, especially for long-stay child patients, but also for the acutely ill. New Clause 5 covers the worthy cases of geriatric patients who are also in great need of visits. As well as being medically desirable, these new clauses would introduce an element of humanity and compassion into a Bill which is riddled with management philosophy.
In Committee the Under-Secretary was full of reassurances, sympathy and understanding. He spoke picturesquely of the "hidden antennae" which go out from his Department into the administration of the hospital world. We found this most comforting, but not enough. We are concerned not only that guidance and encouragement on this matter should emanate from the Department but that a new clause should make it the firm duty of the Secretary of State under the new reorganised health service. We are concerned not only with creating a climate of opinion but with the definite cold print of a new clause.

Sir Robin Turton: I have considerable sympathy for the argument put forward by the hon. Member for Halifax (Dr. Summerskill). In health it is always a battle of priorities. If hospitals are to have extra rooms for parents, particularly in the paediatric wings, there will be less hospital building.
There is great difficulty particularly for children and geriatrics. It is a tremendous burden in geriatric cases, where old parents may be removed far from their homes, to encourage their children or grandchildren to visit them. It often means a tremendous expense on bus fares, or often hiring a car because there are few rural bus services. Therefore, I acknowledge the great need for better provision than we now have for both children and geriatrics.
How is that provision to be met? I think that this should be the responsibility of the Secretary of State for Social Services. There I agree with the hon. Lady. However, I do not believe that the cost should come from the hospital vote. Help is provided from the almoner's funds in hospital welfare. There is also power in local authorities to defray such travelling expenses in cases of hardship. There is a varied execution of that responsibility. I understand from the National Association for the Welfare of Children in Hospital that there is also power in the hands of the Supplementary Benefits Commission, but for some odd reason it apparently does not consider a case until a child has been in hospital for 12 weeks. I should like my hon. Friend to deal with that aspect when he replies.
There must be a complete review of the provision of travelling expenses and the costs of overnight stay for parents visiting children in hospital. It need not be "rooming in", as it used to be called; it could be the provision of accommodation for those who could not otherwise afford it. I believe that this matter should come under another hat of the Secretary of State rather than from the health Vote. I hope that in reply my hon. Friend will give us not merely sympathy but a definite undertaking that something will be done to meet this need, though not necessarily in the terms of the clause proposed by the hon. Member for Halifax or that standing in the name of my neighbour the hon. Member for York (Mr. Alexander W. Lyon).

Mr. Alexander W. Lyon: The York branch of the National Association for the Welfare of Children in Hospital has been extremely active. It was as a result of its representations that I put down new Clause 5. Obviously, it has also been in touch with the right hon.

Member for Thirsk and Malton (Sir Robin Turton).
The Association's approach to me was on the basis of the reimbursement of expenses to children's visitors. I thought that was too narrow a point to take, because of the matters which have been mentioned by the right hon. Gentleman and by my hon. Friend the Member for Halifax (Dr. Summerskill) in her eloquent opening of these matters.
Does it help the health of patients to be visited regularly? That is the decision that the Secretary of State must make. If it does, they ought not to have their health impaired because their relatives are less able to afford to visit them regularly than people who have more means.
The matter is becoming more serious not only by reason of inflation, though that is part of the problem, but by the fact that, as a result of the reorganisation of the health service by successive Governments, greater emphasis is being placed on the general district hospital which will take the place of local cottage or smaller hospitals spread about the country. As a result, a great many people now have to travel further to see their relatives in hospital.
I am very conscious of this problem, for the same reason as the right hon. Member for Thirsk and Malton, because there are so many hospitals in my constituency and a large number of them, as the Minister knows, are connected not only with the long-term sick and the geriatric sick but with mental health. The mentally sick pose a particularly distressing problem. I always find it the most distressing part of my work as a Member of Parliament to go around hospitals where there are long-term geriatric cases or long-term mental health cases, who are left almost alone in the world apart from the devoted attention that they get from the staff or, in the rare cases, from the visitors who constantly come to see them, although, often enough, they cannot communicate with their relatives and dear ones.
This problem is accentuated if they belong to a family in which means are limited and long distances have to be travelled. I do not want to put that barrier in their way. However, I agree with the right hon. Gentleman that funds


should not be made available for this purpose if they have to be diverted from hospital building and the provision of facilities inside the hospital. It is not necessary to provide internal accommodation for visitors, which would be very expensive.
It is possible for the Supplementary Benefits Commission to take on this task as part of its overall responsibility and to pay the visitor even though in normal circumstances that person would not be eligible for supplementary benefit. Many families would not qualify for supplementary benefit, sometimes because the breadwinner is in work, but they none the less have very limited means.
Suddenly, at a moment of sickness, which is a crisis situation for most lower-paid families anyway, also to have the burden of paying heavy travelling expenses is a manifest injustice. Manifest injustices go unrequited in our society simply because normally, there are not the means to help, but here it would not normally be a very expensive operation. I drafted my clause so that the Minister would be able to prescribe the limitations under which any expenses would be paid. One would have to show that it was necessary to visit and that one could not afford to make the visit. So the burden could be kept limited, and, since it is a burden that would fall not on the hospital Vote but on the Supplementary Benefits Commission Vote, there is a possibility that the Minister could meet our demands. I know that he could not do it by accepting either of the new clauses; all that we ask of him is that he considers some way in which it could be done before the Bill goes elsewhere.

Mr. Nicholas Edwards: I welcome this debate on a topic that I have raised a number of times at Question Time. I have great sympathy with the object of the clauses. The only question in my mind is whether they are necessary, whether the powers already exist but are not being used. I will listen with interest to what my hon. Friend says about this.
We are, thank goodness, getting away from the old-fashioned and mistaken idea that children get on better in hospital if they are kept well away from their parents. Yet it was pretty dreadful to be reminded, in the interim report of the

Working Party on Children in Hospital in Wales, that visiting at that time was still restricted at half the hospitals in Wales at which children are nursed. The same report showed that there was a grave shortage of mothers-in units in those hospitals.
If that statement appears to be in contradiction to my suggestion that powers may not be necessary, I am certainly encouraged by the fact that since then, in response to a question from me on 3rd May, my right hon. and learned Friend the Secretary of State for Wales has told me that parents are now allowed free access to their children, including the day of operation, in all hospitals in Wales, subject to certain minor restrictions at some hospitals where the responsible consultant considers it necessary not to allow it on clinical grounds.
As for the contruction of units, at the new hospital which is being built in my constituency at Withybush there are to be units for this purpose, so things are at least happening.
7.45 p.m.
None the less, the final report of the working party gives some strong evidence that action is needed very badly. Forty-two per cent. of the respondents said that that there were no overnight facilities at their child's hospital. The report points out that they may well have been right, but that even if they were wrong this is what they believed and they were not disillusioned. The report emphasises the importance of drawing to the attention of parents the facilities that are available. It says that the staff should always ask, as a matter of routine, whether parents want to come in with their children. We are told that 25 of the 87 mothers who stayed in and were the subject of the inquiry had only an armchair. I do not call that an adequate facility.
Turning to the question of cost, the report said:
The Working Party wish to draw attention to the fact that a minority (12 per cent.) found the cost of transport very difficult to meet and also that cost and difficulties of transport are unusual in that they vary by social class. Other aspects of having children in hospital, including attitudinal ones, did not vary much by social class. The travel difficulties reflect real differences from one social class to another, of income and wealth, and of access to people who have cars.


This is a severe problem in Wales, because of the considerable distances that parents have to travel to hospitals.
The working party observed:
there are inadequate public transport facilities available and also inadequate subsidies for the needy.
The report went on:
The Working Party are concerned…that while the DHSS recommend frequent, preferably daily, visiting of children in hospital, some parents experienced difficulty"—
this point was referred to my right hon. Friend the Member for Thirsk and Malton—
in receiving sufficient benefit from the DHSS (Supplementary Benefit Section) to travel to visit their child in hospital as often as they wished.
The report pointed out that there already seemed to be discrepancies between the various treatments. It drew attention also to the transport subsidy payable in the Highlands and Islands of Scotland and in the Scilly Isles for journeys to hospitals of more than 30 miles, the cost of which, over £1, can be reimbursed without a means test.
In reply to another Parliamentary Question that I put to the Secretary of State for Wales, I received an assurance that this proposal was currently being examined by the Welsh Hospital Board sub-committee on the cost of travelling to hospitals. From that, I understood that the powers presumably already existed. I should like to know whether this is so and whether it is just a question of using existing powers, or whether we may have to have some further provision of the kind suggested in the clauses.
This person has acted with the highest had this valuable report in Wales which I hope will lead to early action. I hope that the deplorable state of affairs that existed previously will quickly be eliminated.

Mr. Brynmor John: I strongly support the new clauses and am disappointed that the Government's undertaking in Committee on 12th April does not appear to have been fulfilled by positive action. The Minister then undertook to consult
to see whether there is anything we can suggest on Report which might meet the Opposition's case "—[OFFICIAL REPORT, Standing Committee G; 12th April, 1973, c. 126.]

Certainly, they have not thought that it was worthy of an amendment. However, I hope that the Under-Secretary will meet what he acknowledged and what we all acknowledge to be a very difficult situation.
Two points arise here. There are grave difficulties for those who are dependent upon public transport. That is so whether they live in towns or in the country, because public transport is becoming extremely expensive. It is a comparatively rare luxury. A person dependent upon public transport for taking his child to hospital, or for visiting that child or any other relative in hospital, is in difficulties anyway and is subject to great expense.
The second point is common to town and country, although I acknowledge that it is more apposite to rural areas than to urban areas. This concerns the distance which the patient often has to travel to reach the hospital. We talk of the necessity for the base hospital. Clearly, in thinly populated rural areas this has meant a great divorce in distance from the home, but it has also been caused by the increasing complexity of medicine. Many specialties are now concentrated in particular areas rather than being dispersed. If a person happens to have the sort of disease which needs to be treated at a distant hospital, wherever the parents or other relatives live the patient is almost inaccessible and the journey to visit him is tedious and very costly.
I agree very much with my hon. Friend the Member for York (Mr. Alexander W. Lyon). In our debates we mostly look on illness as being of the shorter kind, with the short hospitalisation, the curative medicine and the discharge within a month or six weeks. But we should be foolish not to recognise that for certain categories of illness there is no cure and it is a matter of visiting year after year. I am thinking particularly of geriatric patients and patients in mental hospitals. It is no accident that both of these categories are the least visited of all patients in our hospitals. People are able without much difficulty to continue visiting over a comparatively short period, or even a couple of months, but to do it week after week or year after year, with no apparent cure or solution in sight, is a great drain upon people's emotional resources, and an even greater drain on


their financial resources. On the matter of fares, therefore, the Under-Secretary ought quickly to answer this problem.
The new clause mentions the provision of accommodation and other facilities. The Under-Secretary has made the valid point that accommodation is not the only problem of those who visit hospitals. I disagree with the right hon. Member for Thirsk and Malton (Sir Robin Turton) when he says that in competing necessities the adaptation of older hospitals to accommodate visitors overnight is not, perhaps, an important priority. I believe that it is. Fortunately, as the newer hospitals are being built this provision for visitors is being incorporated. The older hospitals are still not adapted. There is a great need for that to be done.
I conclude by highlighting the inadequacy of the financial provision for people in this position by raising anonymously the case of a constituent. I have written to the Department about this case at a local level, but I should like the Under-Secretary's views on the situation. My constituent, a child, has a rare and malignant disease. Although she is very young, her mother is dead and her father has deserted her. She has been raised by an aunt. Because of the rarity and malignancy of the disease, she has to travel to London regularly for treatment. She lives in a village which is about seven miles from the nearest railway station, Pontypridd. A ticket is provided from that station to Paddington Station. The hospital is situated not at Paddington Station but some way into London. The aunt has had to give up work to look after this child, who would otherwise be a charge on State funds. How is the aunt supposed to be able to afford not only the bus fare to the railway station at home but the journey to and from the hospital in London and the subsistence she needs in London for herself and the child?
This person has acted with the highest motives in looking after her neice, but she is being penalised heavily because of the inadequacy of the grants being made available by the Department or by the inflexible way this case is being looked at by the officials who have to deal with it.
Part of the trouble that we are tackling tonight is the legal problem of amending the Bill. That is why I commend these provisions. But part of it is a change in the attitude of people who administer

funds which are already available. I hope that the Under-Secretary will have something to say about both facets. The day has long passed when the visitor is regarded as an unnecessary intrusion upon the practice of medicine. The visitor is a necessary ancillary to medical cure and well-being. I hope that the Minister will give a resounding recognition to that fact.

Dr. Gerard Vaughan: I wish to speak briefly on two points, the first of which follows what was said by the hon. Member for Pontypridd (Mr. John). We are all agreed upon and would support very strongly the value and the need to extend the facilities provided for people to visit not only children and elderly people in hospital but all patients, particularly long-stay patients.
Many facilities are still inadequate, including overnight accommodation, and will take time to implement satisfactorily. But the Under-Secretary can do something now about the point made by the hon. Member for Pontypridd. There is not enough awareness by the staff within hospitals of what facilities are available. It is nurses and doctors on the wards who need to know, for instance, that money is available for travelling, that there are facilities for paying for clothes for children in hospital who are up and about, or that parents who have travelled a long distance should not be sent to an outside restaurant, even if one exists, but should have food provided in the ward. The whole thing could be made easier if a much more positive educational line were taken within the medical, nursing and ancillary professions.
The other point that concerns me very much is that the district hospitals of necessity involve a centralisation, a grouping together of specialist services, but we must be careful not to go too far in this direction. For example, we should not make in our surgical provisions the type of mistake that was made by our predecessors in the last century in the provision of psychiatric care. We do not want huge institutions which are out of touch with patients and the local community, to which people have to travel a long way.
We are now developing a district hospital service in much of the country, but we should also pause to ask whether it is necessary for all the branches of medi-


cine to be at a certain district hospital and whether, having provided the main, central district hospital, we can begin to look much more at small local hospitals which do not need to be so specialised.

8 p.m.

Mr. Charles Loughlin: No one will suggest that this problem is easy of solution. However, the clauses serve as a basis for the discussion of a problem for which successive Governments have been responsible. A number of Governments have created the atmosphere in which there is now an acceptance that visiting is an essential part of the patient's treatment, not merely the geriatric or the child patient, but virtually every type of patient. We have persuaded hospital authorities, by circular and other means, to extend visiting hours and in many instances to ensure that there is free visiting.
There is also the question of the large district hospital. My constituency has two small cottage hospitals—Dilke and Lydney. I represent a county constituency. The hospitals that many of my constituents use are in Gloucester, which is up to 30 miles from villages from which they draw patients.
It is difficult to make suggestions because, like the right hon. Member for Thirsk and Malton (Sir Robin Turton), I should not like to think that the payment of moneys or the provision of overnight accommodation was likely to impinge upon other priorities in the hospital service. We can only begin this discussion at this stage hoping that the social security provisions can be so manipulated as to ensure that assistance can be given to those who are working but are at present precluded from getting social security benefits.
I recognise the difficulty of visiting relatives in hospital from areas like mine. Gloucester hospitals have two visiting periods per day and also weekend visiting periods. If I had known that I would intervene in this debate I would have taken the trouble to discover the exact fares on a very inadequate rural bus service. Without criticising the bus company I say simply that it is not the type of service that exists in cities or towns because hours may elapse between

services. The return bus fare to Gloucester from Coleford and St. Briavels must be in excess of 60p. Even from places much closer to Gloucester the fare is pretty high.
The Government accept the therapeutic value of visiting. If a mother is denied the opportunity to visit her child every day simply because she cannot afford the fares, we are guilty of a deliberate act of retarding the child's recovery if we do not make some provision for the payment of the costs of visiting.
The wording of new Clause 5 is inadequate. I appreciate that an attempt has been made so to frame the wording as not to impose too great a cost, but the wording could be widened considerably. New Clause 4 would be of terrific advantage.
I ask the Minister to devise permissive provisions in the Bill. He could write in a provision to enable the Minister to make recompense for travelling expenses and overnight stays. This would not commit the Minister to its immediate implementation, but it would enable him to invoke the provision when he was able to get reasonable accommodation from the Department of Health and Social Security under whose aegis the Supplementary Benefits Commission comes.

Mr. Roderick: I support the clauses, but I shall confine most of my remarks to new Clause 4.
In Committee hon. Members, almost without exception, referred to their personal experience with children in hospital. That led to a poignant and useful debate, and the Minister must have felt that the case was well put. All of us had had experience of the best practice in assistance with visiting when children are in hospital. We were concerned with the well-being and welfare of the children.
We were all convinced that adequate visiting by parents can assist recovery and overcome a child's fears on entering a large institution such as a hospital. The presence of a parent is of immeasurable value to a child and can be of great assistance to the staff. The parent is of great help in attending to the many needs of the child, whether by providing continuing advice about diet, by washing the child, dressing it, playing with it, or keeping it generally happy and making it


feel that it is not in totally alien surroundings, although obviously the hospital environment will be strange to it.
Travel has become an increasing problem. Centralisation of the services, including the hospital service, has meant that people have to travel greater distances than ever, and this has increased the cost of visiting patients. Last November I asked the Secretary of State for Wales what was the greatest distance a person had to travel in the Principality to visit his nearest district general hospital. The answer was 44 miles. That illustrates the problem that confronts many people. That is a great distance to travel especially if visitors are restricted to half an hour with the patient when they arrive at the hospital. It hardly seems worth while travelling that distance. I know that most hospitals are introducing schemes to allow visitors to stay for longer periods, but those schemes need added momentum. We want the Minister to instruct the hospitals that it is part of their duty to produce such schemes.
There is also the factor of diminishing public transport, which creates problems of accessibility. In these circumstances provision should be made to enable parents to stay at the hospital. It is insufficient simply to provide the money for the fare. In these awkward circumstances there must be facilities for people to stay. In Committee the Minister dwelt almost entirely on the availability of buildings, and complained about the way in which the building programme would be affected by having to provide such facilities. But much can be done without adding any buildings. The clause is necessary to remind the Secretary of State and others of the need. As hon. Members have pointed out, the powers already exist and the clause will therefore provide the necessary pressure for the implementation of what we all seem to want. Let us not regard this as an "either/or" situation—that if we go ahead with this something else will suffer. This is an essential part of the treatment of every patient, and we should consider it in that light.

Mr. Elystan Morgan: The debate has been characterised by a large measure of agreement among hon. Members who have spoken. I am sure that we all hope that when the Minister replies

he will not, albeit in the most dulcet and mellifluous tones, do anything to destroy that agreement. Both clauses have one thing in common. They are designed to improve the lot of the patient by assisting him to maintain the completely necessary contact with the outside world from which he has been separated against his will. New Clause 4 echoes the aspirations and anxieties voiced in the Platt Report of 1959, which examined the welfare of children in hospital. The conclusions of that important study were accepted by the Government of the day. In that year the Ministry of Health went so far as to issue a memorandum to hospitals urging them to implement its provisions as quickly as possible.
The central theme of that report was that children are incomplete, fragile, vulnerable beings and should be treated as such, and not in any way as truncated adults. The report argued that the whole child should be looked after and not just the afflicted limb or organ. One of the strongest recommendations of the report was that everything should be done to avoid the shattering experience suffered by many children because of long separation from their parents. The report summed up the position in these words:
When a child is in hospital he is in danger of losing contact with the outside world, which has been up to that time the background of his development. …It is vital that while he is in hospital he should be visited frequently so that he does not feel that hospital life is divorced from everything he knows.
Later the report said:
We are unanimous in our opinion that the emotional needs of a child in hospital require constant consideration. Changes of environment and separation from familiar people …frequently lead to emotional disturbances which vary in degree and may sometimes last well into adult life.
8.15 p.m.
Those words were written over 14 years ago, but it is apparent that we still fall far short of removing many of the evils located by that study. As the hon. Member for Pembroke (Mr. Nicholas Edwards) reminded the House, in Wales we have the benefit of a complete and incisive study, published last year—the Stacey Report on children in hospital in Wales. That report reveals many glaring deficiencies. It shows that there is a complete lack of a comprehensive children's unit in practically


every hospital in Wales. In addition, in many hospitals there is a completely unwholesome situation, where children are kept in adult wards, where there is no screening of children from other patients in casualty departments, and very often no system for allowing the closest contact to be maintained between the child and its parents, and particularly its mother.
In view of the special study that has been made in Wales I am sure that we would all greatly welcome, in this debate or at some other stage, a statement by the Welsh Office about whether it accepts the findings of the report, whether it is intended to implement those recommendations and, if so, whether the Welsh Office will consider, no doubt in concord with the Welsh Hospital Board—which is soon to disappear under the reorganisation—steps for achieving these ends.

Mr. Gibson-Watt: It may be convenient for me now to answer the points made by my hon. Friend the Member for Pembroke (Mr. Nicholas Edwards) and the hon. Member for Cardigan (Mr. Elystan Morgan), who was kind enough to advise me that he intended raising this matter. The status of the report is that it was made by Miss Margaret Stacey to the Welsh Hospital Board and not to the Welsh Office. The report is being considered by the board, which will no doubt consider recommendations that it will put to the Welsh Office but which it has not yet done. I do not in any way deny the importance of the report, or of what Labour Members have said about this important side of child care in hospitals in Wales.

Mr. Morgan: I am grateful to the Minister of State for that intervention. I appreciate that this report was made to the Welsh Hospital Board, but it is a report of which the Welsh Office is well aware, and it speaks of conditions which are within the direct knowledge of the Welsh Office. Although, therefore, technically speaking it would be discourteous for the Welsh Office to comment on the report until it has received the recommendations of the Welsh Hospital Board, nevertheless, what has been said in this debate will convey strongly to the

Minister of State that action is justified and demanded on the report at the earliest opportunity.
The centrepiece of the new clause is the provision of accommodation for a mother in a hospital where her child is a patient. Ironically, this principle is taken for granted in many primitive and under-developed communities. It seems that it is only in the developed Western world that there has ever been any argument about the necessity for such a system. We appreciate that in the last century, when, in children's wards, doctors were fighting deadly diseases and infection, the highest premium had to be placed on strict order and on asepsis. In those circumstances there was not an appropriate place for parents in the grim atmosphere of the struggle of life or death.
Now, everything seems to have changed with the development of powerful drugs in this century. As far back as 1927 Sir James Spencer established, in the babies' hospital in Newcastle-upon-Tyne, a purpose-built mother-and-child wing. This experiment was followed in scores of western countries, and now there is universal acceptance of the invaluable role of such accommodation, both for the treatment of the child and for the comfort of the mother.
This arrangement also has considerable benefits for the hospitals, for, while the mother cannot take over any part of the nursing role from the medical staff, her action in assisting with the care of her child can enable the medical staff to concentrate their activities on the classical medical role which they were intending to carry out.
No hon. Member would seriously challenge the proposition that this is an extremely important factor in the therapy of the child. We welcome those developments, in addition to the greater liberality with which hospital authorities have in the past five or 10 years viewed the procedures for the visiting of children in hospital. But we want the Minister to state exactly what is the present situation with regard to visiting arrangements and, equally important, to accommodation in hospital for the mother concerned.
Each year 1 million children pass through our hospitals as patients. What percentage were given the opportunity of


having their mothers present for some period of their hospitalisation? The opportunity should be given to every child. It is not sufficient for the facility to be available unless it can be exploited by each parent. As Mr. Justice Darling said, the courts of our country are open to all—but so, he said, is the Ritz Hotel. There is no point in a facility being available for people unless they can avail themselves of it.
For all that has been done by charities, for all the assistance given by hospitals in this matter, many massive gaps remain. This facility must be safeguarded for every parent who wishes to avail himself or herself of it. A parent's lack of financial resources must never result in the parent being deprived of this essential facility. The need of the child, not the financial status of the parent, must come first.
The new clause is not confined to the question of accommodation. It refers to other facilities. I support new Clause 5, in the name of my hon. Friend the Member for York (Mr. Alexander W. Lyon), and have the fullest sympathy for it.
I represent a constituency where from day to day these problems are very acute. Mid-Wales is sparsely populated, and patients, as well as hospital visitors, have to travel distances of 70 to 80 miles. My hon. Friend the Member for Gloucestershire, West (Mr. Loughlin) stated that in his constituency people had to travel 25 to 30 miles to hospitals. That would be regarded as a short distance in my constituency.
The situation has been further bedevilled through the lack of a complete range of specialties in many district hospitals. The question of the provision of a paediatric consultant at Aberystwyth Hospital, in my constituency, has been debated by the Minister of State and myself on many occasions in the House, and I am glad that an appointment is shortly to be made. I hope that the Welsh Hospital Board, no doubt prevailed upon by the Welsh Office, does not impose conditions that would make it difficult for this appointment to be made at an early date. What I have said about the paediatric consultants also applies to the lack of an ear, nose and throat service and of a paediatric wing in the same hospital.
Two-thirds of my constituents are not served by any form of public transport. Add to this the fact that this area of mid-Wales has the lowest income per head of any area in the United Kingdom and we see that there is grave hardship for tens of thousands of people when their children or other members of their family have to enter hospital. Many of my constituents can run cars only by doing without some of the basic necessities of life. The question whether or not a patient in hospital should have visitors involves a basic human right. It is, of course, artificial to have that right as a legal concept if economic factors make it impossible for the right to be exercised. We maintain that only by tackling the problem in a bold and imaginative way can such a fundamental right be safeguarded.
8.30 p.m.
The general principle has already been conceded by successive Governments. The hon. Member for Pembroke (Mr. Nicholas Edwards) has already referred to the concessions which are allowed to patients visiting hospitals in the Scilly Isles and the Highlands and Islands of Scotland. That facility does not extend to visitors. A few limited provisions are to be found in the Ministry of Social Security Act 1966, the Children and Young Persons Act 1963, the Public Health Act 1968 and in the National Health Service regulations made in 1950 regarding expenses in attending hospitals. There is no general provision for visitors save the discretion vested in the authorities under Section 2 of the Ministry of Social Security Act 1966.
If the needs that have so clearly been shown during the debate are to be met there must be new and comprehensive legislation to deal specifically with the problem. The fragmented legal powers that now exist are inadequate. No hon. Member would ever support the proposition that a child should remain in hospital without regular visits by its parents, or that a person who has been extremely ill, with the flame of life flickering low, should be deprived of visitors.
Nevertheless, in the circumstances in which we live, unless we are willing to pass these two new clauses we shall deny basic human rights to tens of thousands of people in Great Britain. It is for


those reasons that I commend both new clauses to the House.

Mr. Alison: There have been three strands to this warm-hearted and humane debate about the provision of the needs of children in hospital: first, the question of accommodation; second, the payment of travelling expenses for parents visiting children; and third, the rather wider new Clause 5, in the name of the hon. Member for York (Mr. Alexander W. Lyon), which refers to the provision of travelling expenses of relatives and not necessarily relatives of children in hospital.
On the first strand, the broad question of accommodation and parallel facilities for those parents who visit their children in hospital, I owe the House, as the hon. Member for Pontypridd (Mr. John) reminded the House, an explanation for not bringing forward a specific amendment as I did in Committee The explanation is simple. Hon. Members will recall that I reminded the Committee that we already make substantial and active provision for patients' relatives by way of accommodation and other facilities. The issue is whether we should make explicit in the Bill in some shape or form the provision which we are already making.
The only place in which we could have done so was in the context of Clause 2—namely, the Secretary of State's general obligation to provide throughout England and Wales, to such extent as he considers necessary to meet all reasonable requirements, hospital accommodation and various other services. We thought on reflection that it would be unnecessary and probably undesirable to make explicit that the Secretary of State's duty under the clause to meet all reasonable requirements for hospital accommodation extends to accommodation for visitors.
That duty covers a vast and complex range of facilities. It would be impracticable to spell them all out in the Bill and wrong to single out provision for visitors for explicit mention rather than the necessity of providing, for example, operating theatres or X-ray facilities. It seems that the appropriate place to state what is necessary is in building notes and other policy guidance and letters to hospital boards. That is the best way of doing it.
It is in that context that we have sought to do a great deal. I add in parenthesis, although I see that my hon. Friend the Member for Reading (Dr. Vaughan) is not in the Chamber, that the publicising of what we already encourage hospitals to do and what many hospitals can do is an important point. I think that we shall get more publicity through the sort of communication with hospital authorities to which I have referred than by trying to put the clause in the Bill. There will he less awareness of what is possible and desirable by including the clause in the Bill than through the measures which I have taken already.
It has been the policy of successive Ministers that parents should be encouraged to visit and stay overnight where necessary. Since the Platt Report of 1959, the matter has been publicised in no fewer than four hospital memoranda—in 1959 and again in 1966, 1971 and 1972. The hon. Member for Gloucestershire, West (Mr. Loughlin) will recall some of these hospital memoranda because he was associated with them.
Then again, the existing building guidance recommends a proportion of single rooms as being desirable for new hospitals and suitable for a mother and child as part of the children's ward accommodation, and the provision of waiting and interview rooms for parents and relatives generally—not only the parents of children. A circular letter which we sent out last year to hospital authorities asked them to review the facilities available for parents taking meals in hospital. This is an instance of the sort of care and need we have in mind—the use of staff dining rooms, the provision of separate places for parents to eat food brought in, and the use of vending machines. All these things, we have reminded hospitals, have to be looked at in the context of the needs of visiting relatives or parents.
The 1972 letter to the hospital authorities said that, where the hospital considered the parents' presence necessary for the child's wellbeing, meals and accommodation should be free. I again underline that it is common policy on both sides of the House that it is essential for everything to be done to humanise and familiarise the hospital environment from the point of view of the child in the


interests of his speedy recovery. This means making it as home-like as possible in the context of the children's unit, and, above all, that parents or other close relatives should be encouraged to take part in the whole process of recovery, being there as much as possible and, if necessary, living there.
Since we are still not satisfied, however, that everything possible has been done. the working party between my Department and the British Paediatric Association, which is considering, again in the broad, the question of hospital accommodation for children, will specifically include in its consideration the whole aspect of accommodation and the participation of parents in the hospital process. So we have issued a lot of guidance and will continue to do so, and we have particular needs under review. So much for the question of accommodation. We believe that there is no need for an amendment to the Bill, or indeed, for an attempt to publicise what it would amount to, because the powers of action are already there.

Mr. Elystan Morgan: While accepting that the Department is fully convinced of the need for such accommodation facilities in every hospital, and that the circulars have been sent out, presumably with some record kept of what reaction there is, may I ask the hon. Gentleman whether he is able to give a target date by which these facilities will be provided by every hospital in the land?

Mr. Alison: I could not give either a target date or the sort of figures for which the hon. Gentleman asked earlier on the question of participation by parents in the millions of stays which children make in hospital. It would impose an onerous duty on the staff of hospital authorities to ask them for further statistics.
On the question of ideal provision for parents, we are still, in the context of the working party, trying to determine what is the ideal. It would be wrong to specify and oversimplify. Such a target might well have to be reconsidered later.
The two other strands in the debate are the question of support for cost of travelling of parents particularly and of other relatives visiting people in hospital. I listened carefully to the hon. Member

for Pontypridd, who presented a moving personal constituency case. Without being able to go into the matter carefully, it struck me that it should have been possible under existing legislation for the child who had to visit the hospital to receive all necessary financial support for the travel to and fro. These aspects come into the ambit of support provision. I shall examine carefully what the hon. Gentleman said and why the escort in this case was not susceptible of support for travelling expenses. Facilities are available for escorts to be subsidised where the need is pressing. I will look into the case and, if necessary, ask the hon. Gentleman to provide me with further details.
The ideal on this question of travelling expenses for parents visiting children in hospital is, I suppose, that postulated by the National Association for the Welfare of Children in Hospital. The association's aim, with which I believe the Opposition identify themselves, is that there should be no discrimination and that financial assistance should be made available to parents visiting children in hospital irrespective of their means. That is where we come to a great difficulty in the matter of financial and other resources. The association's scheme would cost at least £2 million simply in respect of parents visiting children and it would cost a great deal more under the proposal made by the hon. Member for York. To spend £2 million indiscriminately for parents, including well-to-do parents, in this way is something we should not consider.
We have to remember that at the margin we are having to cut off expenditure on provision vital in terms of health. Two million pounds would be enough to enable us to increase by over half the invalid services, or it could give us 10 operating theatre suites. Is it right that we should spend £2 million in indiscriminate help when many of those concerned are well able to afford the cost themselves? I grant that some cannot find it, but for them we make provision in the Supplementary Benefits Scheme to see that they get support and financial help. That acts as a safety net for those in real need.
I agree with the hon. Member for Gloucestershire, West that it excludes those who are in full-time employment,


but the House must recall that here we are considering the financial contingency for a family who have passed into the care of a hospital a dependent member of the family for whom the hospital will provide not only medical care and attention but also lodging. So there is an offset to the financial problems faced by the family in so far as it is relieved of some of the expenditure normally arising in the context particularly of a child.
Here I come to the point made by my right hon. Friend the Member for Thirsk and Malton (Sir Robin Turton), the reference to a 12 weeks' wait before payment was available under the Supplementary Benefits Scheme. I think it arises under the context in which the scale rate payable for a dependent child who goes into hospital is left unchanged for 12 weeks. That is to say, the payment is made in respect of that dependent child as if he or she were living at home and all board and lodging were catered for in the hospital and treated as if the child were still at home. Only after that is a reduction made in the scale rate payments for the child, but it is a reduction very much less than the cost which the hospital has taken on in supporting the child.

Sir Robin Turton: This is the wrong way of looking at it. The Supplementary Benefits Commission should look at the expenses which the parent in need cannot afford in visiting the child in hospital. It is equally important for the parent to visit the child in the first four weeks in hospital as it is in the 20th or 30th week; in fact rather more important. I hope my hon. Friend will ask the other side of his Department to look at this.

8.45 p.m.

Mr. Alison: I can further reassure my right hon. Friend. The general proposition is that because there is no reduction in the scale rate there is a net increase in the financial resources available to the average supplementary benefit family which has lost a dependant to the hospital. If, even in this context, there is hardship and difficulty involved the 12-week rule can be broken and supplementary benefit can be paid earlier.

Dr. Summerskill: Would the hon. Gentleman not agree that to quote the

estimate of the national association, which took an overall amount, as being "indiscriminate payment to any parent" who wants to visit is rather unfair because it is clearly laid out in the terms of the new clause that it is for the Secretary of State to make regulations covering
the nature, mode and scale of such facilities"?
We are not proposing such a wide scheme as the national association. Have not the Government, before they came to this debate, made their own plans about what might be a system of remuneration? Certainly it would not be an overall one. There would clearly have to be some kind of means test.

Mr. Alison: If the hon. Lady is saying that her party does not go the whole way with the national association's scheme for indiscriminate payments she is in terms saying that she believes in some sort of discrimination, which is what happens at present. We discriminate in respect of those who are on supplementary benefit and are self-evidently needy. We do not make provision for those not on supplementary benefit who can clearly meet the modest amount out of their own pockets.
The clause is a little vague. It does not talk in the context of financial assistance about travelling expenses. It goes very much wider. We are not talking about financial assistance simply for travelling expenses. The phrase is used in the context of:
other facilities, including financial assistance
which may be much wider. This is one of the reasons why we could not make an open-ended commitment of this character.

Mr. Cledwyn Hughes: The hon. Gentleman is not dealing with the point put by my hon. Friends; namely, the large category of people outside those in receipt of supplementary benefit and who might have to travel considerable distances of 70 miles or more. In my area it is possible that for certain specialties parents may have to travel 100 miles to Liverpool or to the Wirral. What does he have to say to this? People in low income groups cannot afford even weekly visits over such long distances. The hon. Gentleman is making a sympathetic speech but is falling down on this point.

Mr. Alison: The right hon. Gentleman has singled out the admittedly grey area about which it is extremely difficult to be specific in terms of real need; that is, those who may be hard-pressed financially but are above the supplementary scale rates or are in full-time employment but cannot afford this kind of expense. There may be real and substantial cases here. As I have said, the supplementary benefits scheme can still pick them up if there is a real and emergency need.
I concede that there is a real problem for those who are hard-pressed. It is one which the hon. Member for York has attempted to meet. It is in this context that I should address myself to his clause. He has taken the point that it is reasonable to make discrimination in respect of need. He has also taken the point made by his right hon. Friend the Member for Anglesey (Mr. Cledwyn Hughes), that need goes rather wider than the supplementary benefit scale rates and extends to those who are hard pressed.

Mr. Loughlin: The hon. Gentleman has attempted to reply to a point I made. I want clarification of it because it is essential that this should be broadcast if what he is saying is true. Can he tell us what are the emergencies to which he refers when he says that a visit to a patient can be assisted through supplementary benefit, even though a person is working?

Mr. Alison: The best thing I can do is to refer the hon. Gentleman to the memorandum which we have circulated. I will send hon. Members a copy so that he can read the terms. It is the "Travelling expenses and transport for hospital patients and visitors" memorandum of May 1973. I am turning rapidly through it. I think the relevant columns are 31 and 32. I will send the hon. Member a copy and he can read the document in full. It is published and is widely known and available in the hospital world.
I come to the attempt by the hon. Member for York further to refine selectivity, discrimination, in respect of need. He uses telling phrases, selection "in accordance with needs", "in accordance with the gravity of the illness", "in accordance with the notion of reasonableness". He is attempting to carry these discriminating factors forward into this

grey area beyond the rather crude but simple limits imposed by the Supplementary Benefits Commission—to the grey area where people's needs are above the supplementary benefit level but are still indeterminate, and where people may he hard pressed. He is attempting to define the instrument of selectivity here. This is the difficulty we find when we try to do this. He is imposing upon hospital authorities-not the Supplementary Benefits Commission, because the Supplementary Benefits Commission is, as it were, under stated statutory limitations and cannot help in this particular dimension—the duty of making the sort of assessment of real needs based upon reasonableness, gravity of the illness, and means of the patient, which would enable special payments to be made over and above the group helped by the supplementary benefits.
This would place an impossible load of additional demands upon medical or ward staff, and it would be quite disproportionate to the sort of help which might emerge at the end, unless a complex administrative system were established in hospitals to record visits, to determine the need to visit in relation to the gravity of the illness, to investigate the means of visitors. Such a scheme would be wide open to abuse. The system necessary to check claims for travelling expenses would place heavy demands on hospital staff who are not equipped to investigate means of visitors, and local social security staff, who, goodness knows, are hard pressed enough at the present time, might have to be called in.
Determination of those cases considered to be grave enough by the hospital authorities to warrant the payment of expenses would inevitably involve hospital staff in making discretionary judgments which would be a source of discord between patients and their visitors and the staff responsible. We think that this attempt to break up the crude levels postulated by supplementary benefits would put a heavy burden upon the hospital administration and might be a source of ill will among people who fell upon the wrong side of the line of the determination, and also among patients and visitors and the hospital staffs. Therefore, on its own terms, the clause is unacceptable.

Mr. Alexander W. Lyon: The Under-Secretary is making rather heavy weather of a very simple clause. All I am asking is that the Secretary of State should prepare a scheme. Who administers it will lie within the power of the Secretary of State to determine under regulations. Already almoners do something of this nature in an ad hoc way. All I am asking for is a scheme to be prescribed by regulations—to be administered by almoners, since they already do it. They would then be able to make the kind of decisions they make at the moment, but upon a statutory basis instead of an ad hoc basis. They already discriminate. Why should they not discriminate upon a statutory principle? This is what I am asking.

Mr. Elystan Morgan: Since 1964 in two parts of the United Kingdom, in the Scilly Isles and in the seven crofting counties of Scotland, a scheme which is not based on any means test at all has been implemented. That scheme is run by the hospitals themselves.

Mr. Alison: I need notice of the reference which the hon. Gentleman made to the Isles of Scilly. He appears to have direct knowledge of this area. I will follow up what he has said about the Isles of Scilly and consider it.
The hon. Member for York is not facing the problem of putting into statutory form this statutory and, therefore, universal national requirement for hospitals to look into every case in which the relative of a patient in hospital who is above the supplementary benefits level could still call upon the hospital to assess the reasonableness of the cost of the visit, the lack of means and the gravity of the illness of the patient in hospital. The hospital would be bound to do this—either the almoner or the hospital administrative staff. The staff would quickly get gummed up and, instead of

being concerned, as it properly should be, with the health of the patient, would be concerned with a dispute—probably an angry one—with relatives who are arguing about how much they can afford to pay to come to see the patient.

The scope for voluntary help must not be overlooked. Voluntary help can play an effective rôle here, particularly in organising voluntary transport services which in needy cases can help both the physical and financial strain. We are concerned about not only the financial strain but the distance, the time consumed and the energy used in visiting.

After consultation with a number of voluntary organisations, a circular to hospital authorities on this subject was issued last month. It included the suggestion that the running expenses of a voluntary transport system might be a worthwhile objective for the fund-raising activities of hundreds of leagues of friends and similar bodies which are active throughout the country.

I believe that the Opposition have conceded in their speeches the essential point about which we are concerned, that in travelling expenses discrimination must be made in respect of need. This is already done through the Supplementary Benefits Commission and we should not put further assessing rôles and duties on the hospital administrative staff.

In the matter of accommodation we are all square. A lot has been done. More could be done, and we are proposing to have it done. The clause is redundant and, in so far as it is vague about financial commitments, undesirable. I ask the House to reject it.

Question put, That the clause be read a Second time: ——

The House divided: Ayes 246, Noes 272.

Division No. 149.]
AYES
[9.00 p.m.


Abse, Leo
Bennett, James( Glasgow, Bridgeton)
Buchanan, Richard (G'gow, Sp'burn)


Allaun, Frank (Salford, E.)
Bidwell, Sydney
Butler, Mrs. Joyce (Wood Green)


Archer, Peter (Rowley Regis)
Bishop, E. S.
Campbell, I. (Dunbartonshire, W.)


Armstrong, Ernest
Blenkinsop, Arthur
Cant, R. B.


Ashley, Jack
Boardman, H. (Leigh)
Carmichael, Neil


Ashton, Joe
Booth, Albert
Carter, Ray (Birmingh'm, Northfield)


Atkinson, Norman
Boothroyd, Miss B. (West Brom.)
Castle, Rt. Hn. Barbara


Bagier, Gordon A. T.
Bottomley, Rt. Hn. Arthur
Clark, David (Colne Valley)


Barnes, Michael
Boyden, James(Bishop Auckland)
Cocks, Michael (Bristol, S.)


Barnett, Joel (Heywood and Royton)
Broughton, Sir Alfred
Cohen, Stanley


Baxter, William
Brown, Hugh D. (G'gow, Provan)
Coleman, Donald


Beaney, Alan
Buchan, Norman
Concannon, J. D.




Corbet, Mrs. Freda
Janner, Greville
Parker, John (Dagenham)


Cox, Thomas (Wandsworth, C.)
Jay, Rt. Hn. Douglas
Parry, Robert (Liverpool, Exchange)


Crawshaw, Richard
Jeger, Mrs. Lena
Pavitt, Laurie


Cronin, John
Jenkins, Hugh (Putney)
Peart, Rt. Hn. Fred


Crosland, Rt. Hn. Anthony
John, Brynmor
Perry, Ernest G.


Crossman, Rt. Hn. Richard
Johnson, Carol (Lewisham, S.)
Prentice, Rt. Hn. Reg.


Cunningham, Dr. J. A. (Whitehaven)
Johnson, James (K'ston-on-Hull, W.)
Prescott, John


Dalyell, Tam
Johnson, Walter (Derby, S.)
Price, William (Rugby)


Davidson, Arthur
Jones, Barry (Flint, E.)
Probert, Arthur


Davies, Denzil (Llanelly)
Jones, Dan (Burniey)
Radice, Giles


Davies, G. Elfed (Rhondda, E.)
Jones, Gwynoro (Carmarthen)
Rankin, John


Davies, Ilfor (Gower)
Jones, T. Alec (Rhondda, W.)
Reed, D. (Sedgefield)


Davis, Clinton (Hackney, C.)
Kaufman, Gerald
Rees, Merlyn (Leeds, S.)


Davis, Terry (Bromsgrove)
Kelley, Richard
Rhodes, Geoffrey


Deakins, Eric
Kinnock, Neil
Roberts, Albert (Normanton)


de Freitas, Rt. Hn. Sir Geoffrey
Lambie, David
Roberts, Rt.Hn.Goronwy (Caernarvon)


Delargy, Hugh
Lamborn, Harry
Robertson, John (Paisley)


Dell, Rt. Hn. Edmund
Lamond, James
Roderick, Caerwyn E.(Brc'n&amp;R'dnor)


Dempsey, James
Latham, Arthur
Roper, John


Doig, Peter
Lawson, George
Rose, Paul B.


Dormand, J. D.
Lee, Rt. Hn. Frederick
Ross, Rt. Hn. William (Kilmarnock)


Douglas, Dick (Stirlingshire, E.)
Leonard, Dick
Rowlands, Ted


Douglas-Mann, Bruce
Lewis, Arthur (W. Ham, N.)
Sandelson, Neville


Driberg, Tom
Lewis, Ron (Carlisle)
Sheldon, Robert (Ashton-under-Lyne)


Duffy, A. E. P.
Lipton, Marcus
Shore, Rt. Hn. Peter (Stepney)


Dunn, James A.
Lomas, Kenneth
Short, Mrs. Renée (W'hampton, N.E.)


Dunnett, Jack
Loughlin, Charles
Silkin, Rt. Hn. John (Deptford)


Edelman, Maurice
Lyon, Alexander W. (York)
Silkin, Hn. S. C. (Dulwich)


Edwards, Robert (Bilston)
Lyons, Edward (Bradford, E.)
Sillars, James


Edwards, William (Merioneth)
McBride, Neil
Silverman, Julius


Ellis, Tom
McCartney, Hugh
Skinner, Dennis


English, Michael
McElhone, Frank
Small, William


Evans, Fred
McGuire, Michael
Smith, John (Lanarkshire, N.)


Ewing, Harry
Machin, George
Spearing, Nigel


Fernyhough, Rt. Hn. E.
Mackenzie, Gregor
Spriggs, Leslie


Fisher, Mrs. Doris (B'ham, Ladywood)
Mackie, John
Stallard, A. W.


Fletcher, Raymond (Ilkeston)
Mackintosh, John P.
Steel, David


Fletcher, Ted (Darlington)

Stewart, Rt. Hn. Michael (Fulham)


Foot, Michael
McMillan, Tom (Glasgow, C.)
Stoddart, David (Swindon)


Ford, Ben
McNamara, J. Kevin
Stonehouse, Rt. Hn. John


Forrester, John
Mahon, Simon Bootle
Strauss, Rt. Hn. G. R.



Mallalieu, J. P. W. (Huddersfield, E.)
Summerskill, Hn. Dr. Shirley



Fraser, John (Norwood)




Freeson, Reginald
Marquand, David Marsdon, F.
Swain, Thomas



Marsden, F.
Thomas, Rt.Hn.George (Cardiff, W.)


Galpern, Sir Myer
Mason, Rt. Hn. Roy
Thomas, Jeffrey (Abertilltery)


Garrett, W. E.
Mayhew, Christopher
Tinn, James


Gilbert, Dr. John
Meacher, Michael
Tomney, Frank


Ginsburg, David (Dewsbury)
Mellish, Rt. Hn. Robert
Tope, Graham


Gordon Walker, Rt. Hn. P. C
Mendolson, John
Torney, Tom


Gourlay, Harry
Mikardo, Ian
Tuck, Raphael


Grant, George (Morpeth)
Millan, Bruce
Urwin, T. W.


Grant, John D. (Islington, E.)
Millar Dr. M. S.
Varley, Eric G.


Griffiths, Eddie (Brightside)
Milne, Edward
Wainwright, Edwin


Hamilton, James (Bothwell)
Mitchell, R. C. (S'hampton, Itchen)
Walden, Brian (B'm'ham, All Saints)


Hamilton, William (Fife, W.)
Molloy, William
Walker, Harold (Doncaster)


Hamling, William
Morgan, Elystan (Cardiganshire)
Wallace, George


Hannan, William (G'gow, Maryhill)
Morris, Alfred (Wythenshawe)
Watkins, David


Hardy, Peter
Morris, Charles R. (Openshawe)
Weitzman, David


Harrison, Walter (Wakefield)
Morris, Rt. Hn. John (Aberavon)
Wellbeloved, James


Hart, Rt. Hn. Judith
Murray, Ronald King
Wells, William (Walsall. N.)


Hattersley, Roy
Oakes, Gordon
White, James (Glasgow, Pollok)


Healey, Rt. Hn. Denis
Ogden, Eric
Whitehead, Phillip


Heffer, Eric S.
O'Halloran, Michael
Whitlock, William


Horam, John
O'Malley, Brian
Williams, Alan (Swansea, W.)


Houghton, Rt. Hn. Douglas
Oram, Bert
Williams, Mrs. Shirley (Hitchin)


Howell, Denis (Small Heath)
Orbach, Maurice
Williams W T (Warrington)


Huckfield, Leslie
Orme, Stanley
Woof, Robert


Hughes, Rt. Hn. Cledwyn (Anglesey)
Oswald, Thomas



Hughes, Mark (Durham)
Padley, Walter
TELLERS FOR THE AYES:


Hughes, Robert (Aberdeen, N.)
Paget, R. T.
Mr. John Golding and Mr. Joseph Harper.


Hughes, Roy (Newport)
Palmer, Arthur



Irvine. Rt. Hn. Sir Arthur (Edge Hill)
Pannell, Rt. Hn. Charles





NOES


Adley, Robert
Balniel, Rt. Hn. Lord
Boardman, Tom (Leicester, S.W.)


Alison, Michael (Barkston Ash)
Batsford, Brian
Body, Richard


Allason, James (Hemel Hempstead)
Beamish, Col. Sir Tufton
Boscawen, Hn. Robert


Amery, Rt. Hn. Julian
Bell, Ronald
Bowden, Andrew


Archer, Jeffrey (Louth)
Bennett, Sir Frederick (Torquay)
Braine, Sir Bernard


Astor, John
Bennett, Dr. Reginald (Gosport)
Bray, Ronald


Atkins, Humphrey
Benyon, W.
Brown, Sir Edward (Bath)


Awdry, Daniel
Berry, Hn. Anthony
Bruce-Gardyne, J.


Baker, Kenneth (St. Marylebone)
Biffen, John
Bryan, Sir Paul


Baker, W. H. K. (Banff)
Biggs-Davison, John
Buchanan-Smith, Alick ( Angus, N&amp;M)







Buck, Antony
Higgins, Terence L.
Proudfoot, Wilfred


Builus, Sir Eric
Hiley, Joseph
Pym, Rt. Hn. Francis


Burden, F. A.
Hill, John E. B. (Norfolk, S.)
Quennell, Miss J. M.


Butler, Adam (Bosworth)
Hill, James (Southampton, Test)
Raison, Timothy


Campbell, Rt. Hn. G. (Moray &amp; Nairn)
Holland, Philip
Ramsden, Rt. Hn. James


Carlisle, Mark
Holt, Miss Mary
Rawlinson, Rt. Hn. Sir Peter


Carr, Rt. Hn. Robert
Hordern, Peter
Redmond, Robert


Channon, Paul
Hornby, Richard
Reed, Laurance (Bolton, E.)


Chapman, Sydney
Hornsby-Smith,Rt.Hn.Dame Patricia
Rees, Peter (Dover)


Chichester-Clark, R
Howell, David (Guildford)
Rees-Davies, W. R.


Churchill, W. S.
Howell, Ralph (Norfolk, N.)
Renton, Rt. Hn. Sir David


Clark, William (Surrey, E.)
Hunt, John
Rhys Williams, Sir Brandon


Clarke, Kenneth (Rushcliffe)
Hutchison, Michael Clark
Ridley, Hn. Nicholas


Clegg, Walter
Iremonger, T. L.
Rippon, Rt. Hn. Geoffrey


Cockeram, Eric
Irvine, Bryant Godman (Rye)
Roberts, Wyn (Conway)


Cooke, Robert
James, David
Rodgers, Sir John (Sevenoaks)


Coombs, Derek
Jenkin, Patrick (Woodford)
Rost, Peter


Cooper, A. E.
Jessel, Toby
Royle, Anthony


Cordle, John
Johnson Smith, G. (E. Grinstead)
Russell, Sir Ronald


Corfield, Rt. Hn. Sir Frederick
Jones, Arthur (Northants, S.)
Scott, Nicholas


Cormack, Patrick
Jopling, Michael
Scott-Hopkins, James


Costain, A. P.
Joseph, Rt. Hn. Sir Keith
Shaw, Michael (Sc'b'gh &amp; Whitby)


Critchley, Julian
Kaberry, Sir Donald
Shelton, William (Clapham)


Crouch, David
Kellett-Bowman, Mrs. Elaine
Shersby, Michael


Crowder, F. P.
Kimball, Marcus
Simeons, Charles


Dalkeith, Earl of
King, Evelyn (Dorset, S.)
Sinclair, Sir George


d'Avigdor-Goldsmid, Sir Henry
Kirk, Peter
Skeet, T. H. H.


d'Avigdor-Goldsmid.Maj.-Gen.Jack
Kitson, Timothy
Smith, Dudley (W'wick &amp; L'mington)


Dean, Paul
Knight, Mrs. Jill
Soref, Harold


Digby, Simon Wingfield
Knox, David
Speed, Keith


Dixon, Piers
Lamont, Norman
Spence, John


Dodds-Parker, Douglas
Lane, David
Sproat, Iain


Drayson, G. B.
Langtord-Holt, Sir John
Stainton, Keith


du Cann, Rt. Hn. Edward
Le Marchant, Spencer
Stanbrook, Ivor


Dykes, Hugh
Lewis, Kenneth (Rutland)
Stewart-Smith, Geoffrey (Belper)


Eden, Rt. Hn. Sir John
Lloyd, Ian (P'tsm'th, Langstone)
Stodart, Anthony (Edinburgh, W.)


Edwards, Nicholas (Pembroke)
Loveridge, John
Stokes, John


Elliot, Capt. Walter (Carshalton)
McAdden, Sir Stephen
Stuttaford Dr. Tom


Elliott, R. W. (N'c'tle-upon-Tyne,N.)
MacArthur, Ian
Sutcliffe, John


Emery, Peter
McCrindle, R. A.
Tapsell, Peter


Eyre, Reginald
McLaren, Martin
Taylor, Sir Charles (Eastbourne)


Farr, John
Maclean, Sir Fitzroy
Taylor,Edward M.(G'gow,Cathcart)


Fenner, Mrs. Peggy
McMaster, Stanley
Taylor, Frank (Moss Side)


Fidler, Michael
Macmillan,Rt.Hn.Maurice(Farnham)
Taylor, Robert (Croydon, N. W.)


Finsberg, Geoffrey (Hampstead)
McNair-Wilson, Michael
Tebbit, Norman


Fisher, Nigel (Surbiton)
McNair-Wilson, Patrick (New Forest)
Temple, Jchn M.


Fookes, Miss Janet
Maddan, Martin
Thatcher, Rt. Hn. Mrs. Margaret


Fortescue, Tim
Model, David
Thomas, John Stradling (Monmouth)


Foster, Sir John
Marples, Rt. Hn. Ernest
Thomas, Rt. Hn. Peter (Hendon, S.)


Fowler, Norman
Marten, Neil
Thompson, Sir Richard (Croydon, S.)


Fraser,Rt.Hn.Hugh(St'fford &amp; Stone)
Mather Carol
Tilney, John


Galbraith, Hn. T. G. D.
Maude, Angus
Trafford, Dr. Anthony


Gardner. Edward
Maudling, Rt. Hn. Reginald
Trew, Peter


Gibson-Watt, David
Mawby, Ray
Tugendhat, Christopher


Gilmour, Ian (Norfolk, C.)
Maxwell-Hyslop, R. J.
Turton, Rt. Hn. Sir Robin


Glyn, Dr. Alan
Meyer, Sir Anthony
van Straubenzee, W. R.


Godber, Rt. Hn. J. B.
Mills Peter (Torrington)
Vaughan, Dr. Gerard


Goodhart, Philip
Miscampbell, Norman
Vickers, Dame Joan


Gorst, John
Mitchell, David (Basingstoke)
Waddington, David


Gower, Raymond
Moate, Roger
Walder, David (Clitheroe)


Grant, Anthony (Harrow, C.)
Money, Ernie
Walker-Smith, Rt. Hn. Sir Derek


Gray, Hamish
Monks, Mrs. Connie
Wall, Patrick


Green, Alan
Monro, Hector
Walters, Dennis


Grieve, Percy
More, Jasper
Ward, Dame Irene


Griffiths, Eldon (Bury St. Edmunds)
Morgan-Giles, Rear-Adm.
Warren, Kenneth


Gryils, Michael
Mudd, David
Weatherill, Bernard


Gummer, J. Selwyn
Murton, Oscar
Wells, John (Maidstone)


Gurden, Harold
Nabarro, Sir Gerald
Wiggin, Jerry


Hall, Miss Joan (Keighley)
Neave, Airey
Wilkinson, John


Hall, John (Wycombe)
Nicholls, Sir Harmar
Winterton, Nicholas


Hall-Davis, A. G. F.
Noble, Rt. Hn. Michael
Wolrige-Gordon, Patrick



Normanton, Tom
Wood, Rt. Hn. Richard


Hamilton, Michael (Salisbury)
Onslow, Cranley
Woodhouse, Hn. Christopher


Hannam, John (Exeter)
Oppenheim, Mrs. Sally
Woodnutt, Mark


Harrison, Brian (Maldon)
Orr, Capt. L. P. S.
Worsley, Marcus


Harrison, Col. Sir Harwood (Eye)
Page, Rt. Hn. Graham (Crosby)
Wylie, Rt. Hn. N. R.


Haselhurst, Alan
Parkinson, Cecil
Younger, Hn. George


Hastings, Stephen
Percival, Ian



Havers, Michael
Pike, Miss Mervyn
TELLERS FOR THE NOES:


Hawkins, Paul
Pink, R. Bonner
Mr. Hugh Rossi and Mr. Marcus Fox.


Hay, John
Pounder, Rafton



Heseltine, Michael
Powoll, Rt. Hn. J. Enoch



Hicks, Robert
Price, David (Eastleigh)

Question accordingly negatived.

New Clause 6

PHARMACEUTICAL SERVICES

'(1) With a view to securing that the number of persons undertaking to provide pharmaceutical services in the areas of different Area Health Authorities or in different parts of those areas is adequate, the Secretary of State may establish a committee to be called the Pharmaceutical Practices Committee for the purposes of considering and determining such applications as are referred to in subsection (2) of this section.

(2) The Secretary of State may at the request of an Area Health Authority declare to be applications to which this section applies any applications made on or after the appointed day, for inclusion in the list kept by that Authority of persons undertaking to provide pharmaceutical services, by persons proposing to provide such services at premises any part of which is situated one quarter of a mile or less from any part of any premises or set of premises which are specified in the request and at which four or more medical practitioners undertaking to provide general medical services provide or propose to provide such services:

Provided that the Secretary of State may make such declaration before any application has been made to the Authority.

(3) Every application to which this section applies made in the prescribed manner to an Area Health Authority shall be referred by that Authority to the Pharmaceutical Practices Committee and any person whose application is granted by the said Committee shall, subject to the provisions of Part IV of the principal Act relating to the disqualification of practitioners, be entitled to be included in the list.

(4) Notwithstanding subsection (2)(b) of section 38 of the principal Act the Pharmaceutical Practices Committee may refuse any such application on the ground that there is already an adequate number of persons undertaking to provide pharmaceutical services in the vicinity of the premises at which the applicant proposes to provide such services.

(5) The Pharmaceutical Practices Committee shall be established in accordance with section 5(6) of this Act and the provisions of that section shall, so far as applicable, apply to the Committee.

(6) Any person who has made an application to which this section applies which has been refused may appeal to the Secretary of State, and the Secretary of State may, on such appeal, direct the Pharmaceutical Practices Committee to grant the application.

The Secretary of State may make regulations:—

(a) prescribing the procedure to be followed and the information to be supplied by an Area Health Authority on making a request to the Secretary of State under subsection (2) of this section;
(b) requiring an Area Health Authority to supply to the Pharmaceutical Practices Committee such information as may be pre-

scribed for the purposes of considering and determining any application to which this section applies;
(c) prescribing the procedure for the determination of applications by the Pharmaceutical Practices Committee and for the making and determination of appeals to the Secretary of State under this section;
(d) requiring Area Health Authorities and applicants to be informed of the decisions of the said Committee and of the Secretary of State'.—[Mr. Ogden.]

Brought up, and read the First time.

Mr. Eric Ogden: I beg to move, That the clause be read a Second time.
I should first declare my interest in the clause, as I have done in previous debates on the National Health Service. I am a parliamentary adviser to the Council of the Pharmaceutical Society, though I am not a pharmacist, as one Government back bencher thought a week ago. I took that to be a compliment from him. So my interest is declared, as it ought to be.
The intention of the new clause is to try to help the Secretary of State to ensure that the number of persons engaged in providing pharmaceutical services in any given area is adequate for the needs of the people in that area. The clause may seem rather long and complicated. To be fair, clauses sometimes have to be written in a long and complicated manner. The new clause takes up a whole page on the Notice Paper because it provides a system of appeals against decisions, and references through to the Secretary of State. Therefore, of necessity, the clause must be rather long.
The new clause is a "revised version"—that might appeal to the UnderSecretary—of new Clauses 2 and 3 which I moved in Committee. There is a full report of that debate in the report of the proceedings of the 16th Sitting of the Committee on Tuesday 22nd May, at columns 938–956. I do not intend to repeat in detail all the arguments that I put forward on that occasion, or, indeed, to answer the arguments that were put against the new clauses, though they were not many. In Committee, on 22nd May, five back-bench Members from both sides spoke on the new clauses. Three backbenchers were in favour of the principle behind the new clauses and two were not persuaded in favour of it.
In concluding the debate the Minister made it clear that whilst he recognised the difficulties and problems he was not persuaded at that date that the clause was the way to solve all or any of those problems. He asked me to withdraw those new clauses so that he and his right hon. Friend could have the opportunity of weighing what had been said, of considering the proposals, and of deciding what, if anything, should be done at later stages. I hoped at that time that, having read what he said and having read in detail what had been said in Committee, he would have brought forward some proposals on Report.
A week ago the Under-Secretary of State met Mt. John Ferguson, the Assistant Secretary of the Pharmaceutical Society of Great Britain and myself in his office at the Elephant and Castle—an appropriate description for some of the team across there. I am grateful to the Minister and his officers for the time that they gave, for their understanding, for the way that we were received, and for their concern. It was—I do not want to use the hackneyed phrase "a full and frank discussion"—useful. We cleared up some points, and I have no doubt about the Minister's concern. However, I regret that that concern was not sufficient for him to bring forward his own proposals on Report.
Since then the hon. Gentleman and his Department have sent me a long, complicated and detailed answer to the points that were made in the discussion, but it is a matter of fact that, so far, none of the proposals that we put forward has persuaded him that this is the way to act. So this is the latest, but not, I assure him, the last attempt to persuade him of the need for this type of action through the new clause.
The need for action outlined by hon. Members on both sides in Committee was referred to in debate after debate. It is agreed by Ministers, Members of Parliament, pharmacists—both members of the Pharmaceutical Society and those who belong to the "company chemists", as they are sometimes called—the Executive Councils, the British Medical Association and the public, that there is cause for concern. That concern arises from the changes in the practice of medicine over the past 20 or 25 years.

Probably no other profession has seen so many changes in such a short time. The relationship or interdependence between doctor and pharmacist is still very close. Each has his own sphere, but the relationship, particularly between the family doctor and the local pharmacist, is extremely close. Their physical proximity has always been very close; the doctor's surgery, the local chemist; the prescriber and the pharmacist—the one to prescribe, the other to dispense.
9.15 p.m.
One of the many changes that have taken place is the establishment of group centres. It is only one of the many changes that have been bringing all sorts of organisations and services nearer to the centre of towns and communities. This has inevitably meant a reduction in the services in the rest of the areas concerned—some people call them peripheral areas, but I prefer to call them community areas.
Where three, four or five doctors have gathered together in a group health centre, which is the overall term for either a health centre or a group practice, surgeries in the other areas, which used to be as much as a mile apart, have closed down, and in almost every town groups of doctors are gathering together in smaller or larger numbers—with, in the Department's own regulations, up to 21 general practitioners in a family centre.
Inevitably, pharmacies have concentrated near the group centres, and the number of pharmacies in the other areas has declined. On occasion, groups of pharmacists have gathered together to provide a joint service and the income from the pharmacy near the group centre has helped to maintain the service in the other areas.
But in this respect, the National Health Service and the Secretary of State have no power to refuse an application for a contract to provide group pharmaceutical services if the applicant is properly qualified and has the right place in which to carry out this service. This contrasts with the restrictions that can be imposed upon the medical profession itself. There are "open" areas where doctors may freely establish their own practices and there are other areas in which there are restrictions. But there are no restrictions


on pharmacists. Local authorities can control carpenters' shops, betting offices, and even chip shops, but they cannot control the number of pharmacies in any area.
In my own area, three years ago, a group centre was established and a shop became a pharmacy. Then another, close to it, and even a garage, became pharmacies. This was happening at the same time as pharmacies in other community areas were closing down. The town of Bury, in the North-West recently had 23 pharmacies, well distributed throughout the area. There are now only 11, concentrated more or less in the centre of the town, close to two or three group practices.
For those who think that a group centre involves only four or five doctors, I would point out that the growing practice is for much larger numbers. In many parts of the country it is not unusual for there to be 14, 16, 17, or even 20 doctors working from one set of premises. When that number of doctors are employed, it means service for an average population of 50,000—a town of no mean size. This is one of the effects. In every other way the Minister can control the provision of adequate services, but not in this respect.
The proposals in the clause are intended to do something about this situation. It has been argued that this is a negative, restrictive attempt. But Ministers and Governments of both complexions have often thought it necessary to have both the carrot and the stick, and the proposals in the new clause would enable the Minister to designate a very small area, which the main area health authority would decide, within a quarter-mile radius of a group centre practice, as one in which there were already adequate services and where further applications to provide additional services at the expense of the other peripheral or community areas could be refused.
The new clause is complicated partly because this will be a two-way traffic. The area health authority, on its own initiative, could decide that an area already had enough pharmacists, that no more were needed, at the expense of other areas, and that the Minister should be asked to designate the area within a

Quarter-mile radius of a group centre practice. The Minister could do this in the reverse order and designate an area on his own information. If there were any further applications for new contracts to provide pharmaceutical services, they would be referred to the Pharmaceutical Practices Committee mentioned in subsection (1).
The purpose of placing the Pharmaceutical Practices Committee on a national basis is so that people in one part of the country shall not be treated differently from those in another. The Pharmaceutical Practices Committee would be able to obtain information and draw experience from all over the country. There would be a fair ratio and equal consideration over the whole country. An applicant whose application was refused would have the right of appeal to the Minister. Equally, the area health authority would have the right of appeal to the Minister. Through the new clause, implemented by regulations at the right time and in places where the Minister considered it necessary and desirable, there would be this limited degree of control over a growing problem.
It was suggested in Committee that the problem was caused by a shortage of pharmacists—the professional men and women. That is not so. It is a strange contrast that in 1954 there were 15,000 pharmacies but in 1973 there are only 12,000. At the same time, the number of professional pharmacists has risen from 26,000 to 29,000. The shortage is not of professionally qualified people but of places where they are operating. This is due to economic and social forces. Pharmacists are going into industry and into other services. However, the proposal in the new clause would have some effect if used where thought necessary and desirable by the Minister.
If so designated the area would be a limited and restricted area, but for every other area in the country the present arrangements would remain and applications for services would be subject to no control except in the small number of areas so designated.
The clause will not solve all the problems of pharmacy or public need. It is only one side of the coin. It does not prevent the Minister bringing forward his own proposals, soon or some time later, to help the community pharmacist.


That would have to be done in another way. We have discussed this matter. All hon. Members who served on the Committee were concerned about the problem. We have put forward a number of proposals and discussed them with the Minister. This is the third set of proposals, which is a revised version streamlined. In effect, this would give the Secretary of State reserve powers, to be implemented at such time and in such areas as he considered this limited degree of control to be necessary.
The proposals have been discussed by the Pharmaceutical Society with their opposite numbers, the chemists' contractors. The British Medical Association has considered the problem and has said in its committee reports that there is a need for this kind of provision and that something ought to be done about this need. The executive councils say that something ought to be done about this need. The Minister has said that he is aware of the problem, and that something ought to be done about this need.
We do not get National Health Service Reorganisation Bills every five minutes. If something is not done in this Bill the opportunity will pass and we shall have years of an ever-growing problem. This is a way in which some of the problems can be met. The clause meets many of the points made in Committee. I hope that it will find acceptance by the Minister.

Mr. John Golding: I support the clause. One of the difficulties that have beset some of my constituents for many years has been that of getting prescriptions made up. Before I discuss the problem in the localities, I think the House should be aware that many people face such difficulties, which will exist whether or not we re-site pharmacies.
The Minister should bear in mind the difficulties of those who are housebound in getting prescriptions made up. This was brought home to me when I recently canvassed for the district elections. I met a very old lady who had had occasion to call in a doctor recently. On being given a prescription she told the doctor that she could not get it made up. He said that she would have to get a neighbour to take it to the chemist. All

the neighbours were very old. This lady had been placed in a ground floor flat in a row occupied by other old people. She explained this to the doctor. The doctor's attitude was "Hard luck". The lady told me that she could not get the prescription made up until she recovered. We must turn our attention to the problem of providing medicines for people, who cannot get prescriptions made up.
In two areas of my constituency—Knutton and The Bradwell—this has been a problem for a long time and people are acutely conscious of it. On several occasions I have raised the question with the Minister, but he has told me that he is powerless.
I am not sure whether the problem of the absence of pharmacists can be dealt with by restricting the mobility of pharmacists elsewhere. My recent experience has been that it is much more likely to come from the siting of health centres because it appears that pharmacists follow general practitioners. This is obvious. People come from the doctor's surgery with a prescription and take it to the nearest pharmacy. Thus, pharmacists tend to be located close to doctors.
To some extent this situation is satisfactory for those who are visiting doctors. It is not satisfactory for those who are being visited by doctors, where the doctor travels some miles to see them, gives them a prescription, and tells them "Take this to the chemists and get it made up", the doctor often being oblivious to the fact that whereas his visit to the patient has been made easily by car the journey for the patient may be very difficult. If a patient is given a prescription at half-past five or six o'clock at night there is often no way of his getting to the chemist to have it made up on that day.
Doctors often do not want to practise in working class areas. Knutton is a substantial village of several thousand people. Because the doctors have preferred to live in another village and because there is now a health centre in that village, there is no doctor in Knutton. Because there is no doctor in Knutton there is no pharmacist there. The same is true of The Bradwell. This is primarily because The Bradwell is a very large council estate of several thousand people. Doctors prefer to live in and have their surgeries in what they regard as the posher parts and when they make calls


on houses in The Bradwell they travel by car. People living on The Bradwell must always travel to the chemists to get prescriptions made up.
When the county council asked the doctors if they would like a health centre on The Bradwell, the creation of which would automatically be followed by an inflow of chemists, the doctors said "No, we would prefer to stay where we are". That is because they prefer the people to have to come to them rather than that they should have to go and live and work amongst the people.
This is a disturbing situation. It is one that we have to tackle at some time or other. We have to create health centres including perhaps pharmaceutical services, and we must say to the doctors that those are the centres in which they must work. There is no reason why we should accept the present intolerable situation in which our people, because they live in working-class areas, are denied medical and pharmaceutical services on their doorstep.
I hope not only that the Government are sympathetic to our pleas but that in the very near future they will take action to ensure that all who are in need get the services they deserve.

9.30 p.m.

Mr. Alison: The hon. Member for Liverpool, West Derby (Mr. Ogden) has referred to the debate we had in Committee on this important subject, and he was discreet and helpful enough in his speech to refer to what he said earlier and not to go in extenso into the full range of arguments he deployed there. With the permission of the House I shall follow his pattern.
The problem which confronts us here was fairly described to us by the hon. Member for Newcastle-under-Lyme (Mr. Golding). He referred to the tendency for all sorts of services and facilities, not only pharmacies and doctors but even social security offices, sub-post offices, village shops, grocers and other services and amenities to tend to concentrate, for example, in shopping centres. They do so for very good and proper reasons of economy and better provision of services and so forth. However, there is an unfortunate by-product where people in suburban and rural environments are

hard hit by the loss of the corner shop. This produces a problem of which we are well aware. We are deeply concerned with the tendency for peripheral pharmacies to be snuffed out by modern developments and we want to do everything we can to sustain these peripheral pharmacies, not to mention the local village doctor or the doctor living in a house close to his patients.
Often in the general development of services, particularly medical services, there are great advantages in getting people together in groups, and this includes social workers, attached health visitors, local authority health services, and so on. There is great advantage here in centralisation and concentration but it produces these peripheral difficulties.

Dr. Tom Stuttaford: Will my hon. Friend ensure that when a vacancy occurs through death in a general practice that vacancy is always advertised so that the local medical authority can find out whether there is any demand among doctors to go to the area? All too often the vacancies are never advertised and it is assumed by the deceased doctor's erstwhile colleagues that no one wants to go to that village or area. If the advertisement were placed in the professional Press it might be found that a great many doctors would be prepared to look after a small area with greater personal contact with the people.

Mr. Alison: I have noted my hon. Friend's remarks. They go wider than the terms of the clause, which relates specifically to the question of pharmacies, but I will think about his suggestion and drop him a line to let him know my conclusion.
I come now to the measures which the hon. Member for West Derby is proposing to try to sustain the peripheral pharmacies. As I contemplate this massive complex clause which it has been necessary to table—excellent and clear as the drafting of it is—I am overwhelmed by the complexity of the steps necessary to achieve what is essentially a negative result. The effect of the clause would essentially be to stop developments—that is, the location of pharmacies close to where doctors practise.
As the hon. Member for Newcastle-under-Lyme rightly pointed out, pharmacists tend to go where the doctors prescribe. There would be power to stop that happening, though there is the self-evident interest of the great mass of patients and consumers in having a pharmacy pretty close to a health centre. That is very convenient. It may produce problems at the periphery, but in positive terms there is an interest for the consumer in having a pharmacy close to a health centre. The power sought in the complex clause is the negative one of simply stopping such developments.

Mr. Ogden: We have argued the matter many times. The Minister knows that it does no such thing. It does not stop development of pharmacies in any area; it allows the Minister to decide that in a given area of a quarter of a mile radius there is already an adequate service. It does not prevent an adequate service for the needs of the people in that area but stops an over-provision, which is exactly what the Minister does with regard to doctors through the provision of medical services.

Mr. Alison: The clause is negative in so far as it seeks to arm my right hon. Friend with powers to keep pharmacies at least a quarter a mile away from a health centre. From the point of view of many consumers, that is not an attractive proposition.

Mr. Ogden: The Minister has said that the clause will keep pharmacists a quarter of a mile away from a group centre. It would not, and the hon. Gentleman knows that it would not. We have argued the matter many times. It would give him the power to say that within a quarter of a mile radius there should be only so many pharmacies. There could be 20 if the area needed 20 and 50 if it needed 50. But if the area required only five to provide suitable services, and the provision of more would be at the cost of services elsewhere, there would be the power to control the number. The clause would limit but not prevent.

Mr. Alison: I return to the general point. The hon. Gentleman may say "limit" if he likes, but it is a negative measure.
The trouble the Government face is that there is no convincing argument that I have been able to understand to suggest that the clause would have a measureable effect upon the fate of the peripheral pharmacy. There is no positive indication that it would do anything to help a peripheral pharmacist faced with a range of problems and not simply a possible decline in the prescribing business, as 50 per cent. of his business is probably concerned with goods and services outside the direct pharmaceutical provisions. Because of supermarkets and other developments, such pharmacists may still be in great difficulty and still be tending to disappear.
I do not believe that the rather complicated measures proposed would be effective in sustaining peripheral pharmacies. We must try to have a more positive way to encourage their existence. We are considering the whole time what should or could be done in that direction.
After weighing up what was said in Committee, and thinking of all the pros and cons of what was a very mixed reception for the proposals in Committee, I cannot see that the clause, which is lengthy, complicated and involved—I say that without in any way denying its precision—would do anything to solve our problem of a declining service at the periphery of small pharmacies affected by a whole range of pressures, not simply by the tendency for the prescriptions to be dispensed near to group practices or health centres.
We want to encourage pharmacists voluntarily to make sensible agreements where practical and possible to come together to share the profit of group or health centre practices. There is nothing in the present arrangements to stop them doing that. Nothing that might arise as a result of a decision by the House against the clause would in any way inhibit pharmacists from voluntarily taking steps on their own account to share out the business where it takes place in the centre, to sustain their own mutual interests in keeping out-of-town pharmacies going. We shall encourage them. We shall specifically ask the new health authorities, when they come into operation after 1974, to give particular attention to the encouragement of sensible voluntary arrangements between pharmacists in a town to share out the business


that might arise in the centre or close to the health centres.
The hon. Member for West Derby will know of the sort of ways in which family practitioner committees in particular will be able to give some fairly positive and active encouragement to existing pharmacists in this context. They will be responsible for setting up health centres. The House will be able to imagine how they might approach and encourage existing pharmacists to make sensible voluntary arrangements to share out the business which may arise without any of the rather complicated provisions which are taken up in the clause.
Against the background of the many pressures to which peripheral pharmacists are subject at present, there is the tendency for a lot of their business outside the purely pharmaceutical range to go to the centre. In that context this rather negative provision provides no guarantee that it will save the peripheral pharmacy. We cannot advise the House to adopt the clause. We shall do everything possible in the reorganised set-up to encourage sensible voluntary arrangements to achieve the same result as the hon. Gentleman is seeking by statutory means. I ask the House to reject the clause.

Mr. Ogden: I thank my hon. Friend the Member for Newcastle-under-Lyme (Mr. Golding) for his words of support. I also thank my hon. Friends who supported me in Committee. We are all agreed that the best way of meeting the need which we are discussing would be to have pharmacies in an area close to the group centre and pharmacies in the local community area for those who need such a service—for example, the very young, the very old and the very ill.
The present situation is undesirable for a whole range of reasons. The Minister will agree that those reasons have been put to him clearly, carefully and cogently with all the information which we could possibly give. It must be accepted that the hon. Gentleman has responded by making time available for meetings to take place. In his reply the Minister complimented my discretion and brevity. I well remember the occasions when I have sat with my hon. Friend the Member for Huddersfield, West (Mr. Lomas)

waiting for Ministers to wind up before 12 o'clock, so we could catch our trains home. I shall be brief tonight.
Brevity is all right and argument is all right if the Minister is open to persuasion. The back benches are often the worst and the last place from which to persuade Ministers. To a degree hon. Members waste their time in trying to do so. If we cannot persuade them in their own offices we have little chance of doing so in the Chamber. I am afraid that tonight the Minister was no longer open to persuasion. It is my view—I do not know whether this is or is not the view of the Pharmaceutical Society—that the Minister's decision to reject the opportunity of having these powers is a purely political decision. He said that the proposal had a mixed reception in Committee. In fact, there were three hon. Members in support from both sides and two in opposition from his side. That is another argument. I consider that the Minister has made a political decision for political purposes rather than a practical decision for pharmaceutical purposes. I regret that I cannot withdraw the clause. It is up to the House to make its own decision.

Question put and negatived.

Clause 2

GENERAL POWERS AND DUTIES OF SECRETARY OF STATE TO PROVIDE SERVICES

Mr. Alison: I beg to move Amendment No. 1, in page 2, line 7, leave out '(except in Greater London)'.

Mr. Deputy Speaker (Mr. E. L. Mallalieu): It will be convenient to take with this amendment Government amendments Nos. 3, 4, 5, 6 and 35.

Mr. Alison: The aim of this group of amendments is to bring the London Ambulance Service within the reorganised National Health Service. That was the original intention of the Bill which was frustrated, as the House knows, in another place. The Government had a chance in Committee, as a result of the eloquence of the hon. Member for Southwark (Mr. Lamborn), to consider the argument which he advanced for leaving the London Ambulance Service with the Greater London Council. On considering the matter further, the Government have


concluded that the case for the transfer of the London ambulance service to the reorganised National Health Service is overwhelming.
9.45 p.m.
The Bill is specifically designed to integrate the fragmented services—hospitals, general practitioners, local authority health services, and so on—with the purpose of establishing comprehensive health care, stemming from a single source authority and competent, through that authority, to mobilise every necessary resource for the delivery of health care. Ambulances are indisputably an integral part of the armoury of health resources necessary to look after the health and well-being of patients.
This is par excellence true in the case of the London ambulance service because, unlike other ambulance services run by local government, it has never had social services responsibility. It has been purely a health instrument. It is not only in the context of the need to mobilise health resources generally that we believe that in London the ambulance service should pass to the National Health Service. We believe that it should be done particularly in view of the intimate involvement the ambulances have with the hospital service, above all with the accident and emergency departments. This is where, above all, ambulances are crucial, and there could hardly be a dimension in which health care is more specifically and precisely featured than in the provision of emergency and accident services in hospitals, necessitating transport by ambulance to get the unfortunate patients into that environment.
All these arguments have been accepted in the case of local authorities outside London as a reasonable basis for transferring the ambulance services which for many years—much longer than in London—have been run by local government. All these factors have justified there being no question of transferring the ambulances into a reorganised NHS.

Mr. John Silkin: I have had a number of complaints—I do not know whether the hon. Gentleman has—that some staff seem totally unaware of the terms and conditions in which they will be operat-

ing in the ambulance service when they are transferred. Perhaps on Third Reading the hon. Gentleman may care to make a statement on that.

Mr. Alison: I will. I take the point.
The question to consider is whether London, with one of the largest ambulance services in the country, should be the odd man out in withholding its ambulance service from the reorganised NHS, especially since the London scene features the concentration of large hospitals, many of them specialist teaching hospitals, to which a very large number of people from outside London automatically flow for a whole range of services. So, above all, if ambulances are an integral part of health care, should they not be integrated in a health service in London, where there is need to co-ordinate the movement of patients, many of them from outside London, coming into the great London hospitals?
In Committee many hon. Members spoke of the aspect of democratic control as something important in the present set-up, in which the ambulance service in London is under the direct control of the Greater London Council, an elected body. But there was never any problem in the case of the local authority health services being transferred from local government to the reorganised NHS. Both parties have supported this. The principle of the removal of local authority health services at large into the reorganised NHS has received bipartisan support. It was a major feature of the last Green Paper issued by the Labour Government on the health services, and we have simply carried it forward into this Bill.
Therefore, if it was right and caused no offence to democratic principles to transfer health services from local government, why on democratic grounds should the ambulance service in London alone be excluded? There is no rational basis for doing so. The argument of democratic control is further weakened because under the old set-up the subordinate local authorities in London have been precepted by the GLC for the funds for the ambulance service, whereas under the Bill the full financing of the London ambulance service will be placed on the Secretary of State.
It is a negation of democracy that all the financing should be in the hands of my right hon. Friend and the democratic representation, so to speak, in the hands of the GLC which has no responsibility for raising the money but responsibility only for spending it. This is a negation of the concept of representation on the basis of taxation. There is a perfectly adequate democratic basis for the running of the centralised National Health Service; that is, this House of Commons. It is looked after by the skilled debating power of the Opposition and my hon. Friends.
Some argue that the GLC has operated the ambulance service very well for a long time, but in fact the GLC has been running it only since April 1965, a very much shorter time than the great bulk of ambulance services have been operated outside London, where many authorities have had them since 1946. The GLC got the service only because it was necessary to move services from Croydon County Borough and Middlesex County Council and integrate it in the GLC. We are simply perpetuating and extending the principle of unification and centralisation, which is the way in which the GLC got its ambulance and all its health services.

Mrs. Freda Corbet: Has the hon. Gentleman never heard of London County Council, the predecessor of the GLC, which ran a very large ambulance service which was the core of the GLC service as it is known today?

Mr. Alison: Yes, indeed, I believe I was associated with the London County Council when the hon. Lady was a distinguished member of it and I recall with pleasure the exchanges we had. Of course I am aware of this, but I am arguing that the Greater London Council control of the ambulance service is a combination of different strands from the past—the Croydon service and the LCC and Middlesex services—and that has been a GLC service for only a short space of time. All we are doing is extending the principle into the National Health Service where, clearly, ambulance services belong.
We shall have a London ambulance committee operating in a similar way to the Greater London way of running the service. On that committee there will

also be regional health authorities in the Greater London area and authorities outside which have a great interest in the transportation of patients by their ambulances into the metropolis. We think there is an overwhelming case for the integration of a fragmented service into a single service within the ambit of the reorganised service.

Mr. Geoffrey Finsberg: Could my hon. Friend say whether this London ambulance committee in all its actions will be subject to review by the proposed health service commissioner in the event of alleged maladministration?

Mr. Alison: Yes, of course. As soon as the London ambulance service moves into the ambit of responsibility of the Secretary of State for the Social Services it will be susceptible not only to scrutiny by the health councils but also to the ombudsman after complaints have been considered by the authorities immediately responsible for managing the service. It is right to complete the process by bringing into a single health authority this vital component in the mobilisation of forces for health care.

Mr. Harry Lamborn: Having emerged from my first blooding in Committee I confess that I found it a matter for regret that, no matter how strong was the case put forward for making certain changes in the original Bill, and no matter how strong such changes might have been supported on all sides of the Committee—until the vote was taken—the Government have pressed forward with their original proposals and have not been prepared seriously to consider any amendment to the proposals first placed before the House.
It is perhaps rather ironic and certainly in keeping with the pattern that the first and only substantial amendment to be moved by the Under-Secretary should be designed not to improve on original thoughts as a result of the passage of the Bill but to correct what the hon. Gentleman described as the frustrations of the original intentions of the Bill by another place in leaving the London ambulance service under the control of the Greater London Council.
The case for the retention of the London ambulance service in its present form under the GLC is overwhelming. The


hon. Gentleman said that the service as at present constituted had been in existence only since 1965. As my hon. Friend the Member for Peckham (Mrs. Corbet) pointed out, there has been a London ambulance service serving the administrative county of London for almost 40 years. As Chairman of the London County Council Health Committee for the last three years of LCC administation I took part in the negotiations which led to an even finer London ambulance service covering the enlarged area of London.
It is rather ironic that it was the proposals of the last Conservative administration which recognised that there was a special case for placing the ambulance service in London not under the control of the local health authorities, as was the position throughout the country, but under the control of the GLC. The reasons which led the Government of the day in 1963 to conclude that this was a proper course are certainly as valid today as they were then. I contend that the ambulance service in London is probably the finest of its kind in the world. Certainly that is the view of the people in London because the GLC conducted a poll asking the citizens which service within the London area they considered best served the people of London, and the London ambulance service was selected by an overwhelming majority.
It is not with the approval of the citizens of London that the ambulance service is being taken out of the control of the GLC, which was democratically elected by the people of London to run that service and to be accountable to them for it. Certainly it is not the view of the Greater London Council, neither the majority party nor the minority party, and no doubt the Under-Secretary of State has had——

It being Ten o'clock the debate stood adjourned.

Ordered,
That the National Health Service Reorganisation Bill [Lords] may be proceeded with at this day's Sitting, though opposed, until any hour.—[Mr. Murton.]

Question again proposed, That the amendment be made.

Mr. Lamborn: As I was saying, the leaders of both sides of the Greater

London Council are of the view that the London ambulance service should remain under the control of the Greater London Council and I have no doubt that the Under-Secretary, like myself, has had representations from both Sir Reginald Goodwin and Sir Desmond Plummer urging the Government to have second thoughts about control of the service. Speaking from experience I would say that that view is shared by all members of the Greater London Council.
The Secretary of State's case in persisting with this proposal is not that it will make the service more efficient, not that it will result in financial savings—indeed, I expect to be able to indicate clearly that additional expense will be incurred—and certainly not that the change is wanted by the people of London. His case is merely the desirability of uniformity with the rest of the country, a uniformity the Conservative Government themselves rejected in 1963 when establishing the London ambulance service on its present basis.
In Committee the Under-Secretary indicated that it is the intention of the Secretary of State to create a joint committee from four regional authorities, and, as the Under-Secretary has indicated this evening, instead of the service being controlled by the council elected by the people of London, a new control of the ambulance service covering the GLC area is to be provided. Even the Secretary of State has realised that it is essential to keep the service as a going concern because it would be most difficult to replace; it would be difficult to create anything of a similar pattern. What is going to be different is the administration. The service is to be controlled by an ad hoc body formed by representatives of four regional authorities of whom, the Secretary of State indicated in Committee, the majority would come from outside the Greater London area. Instead of the service being administered by people elected by the citizens of London it will be adminstered by persons appointed by the Secretary of State himself.
Perhaps the worst aspect of tearing the ambulance service away from the control of the GLC is the separation of that service from the other services of the council. The first and most obvious matter for concern is the separation of


the service from the unified control of the London fire and rescue services. London has on many occasions been thankful for the close co-ordination of these services, which in times of major disaster has been responsible for the saving of life and limb.
The dangers which arise from the lack of co-ordination are illustrated by the delays which occurred in the recent bombing outrages in London, when precious minutes were lost because the existence of two police organisations in the London area led to a lack of co-ordination which a unified service would avoid.
The London ambulance service will also be separated from other vital services of the GLC. In addition to an ambulance fleet of 1,000 vehicles, the GLC has 2,000 other vehicles and an organisation equipped to maintain that fleet. It also has a vehicle body-building section which has given a lead in ambulance design to local authorities throughout the country. The regional

boards will have to create an organisation to maintain this vast ambulance fleet. This can be done only at considerable expense, and the whole operation will reduce efficiency.

The Under-Secretary of State referred to the need for close liaison with the hospitals. I do not think he would suggest that the present close arrangements between the London ambulance service and the hospitals falls down through lack of efficiency. There is the closest co-ordination at hospital level.

I conclude by urging the Secretary of State not to take the London ambulance service away from the elected representatives of the people of London merely for administrative tidiness and a built-in resistance to democratic control—which appears to have been the theme throughout the passage of the Bill.

Question put, That the amendment be made:—

The House divided: Ayes 268, Noes 246.

Division No. 150.]
AYES
[10.10 p.m.


Adley, Robert
Cockeram, Eric
Goodhart, Philip


Alison, Michael (Barkston Ash)
Cooke, Robert
Gorst, John


Allason, James (Hemel Hempstead)
Coombs, Derek
Gower, Raymond


Archer, Jeffrey (Louth)
Cooper, A. E.
Grant, Anthony (Harrow, C.)


Astor, John
Cordle, John
Gray, Hamish


Atkins, Humphrey
Corfield, Rt. Hn. Sir Frederick
Green, Alan


Awdry, Daniel
Cormack, Patrick
Grieve, Percy


Baker, Kenneth (St. Marylebone)
Costain, A. P.
Griffiths, Eldon (Bury St. Edmunds)


Baker, W. H. K. (Banff)
Critchley, Julian
Grylls, Michael


Balniel, Rt. Hn. Lord
Crouch, David
Gummer, J. Selwyn


Batsford, Brian
Crowder, F. P.
Gurden, Harold


Bell, Ronald
Dalkeith, Earl of
Hall, Miss Joan (Keighley)


Bennett, Sir Frederic (Torquay)
d'Avigdor-Goldsmid, Sir Henry
Hall, John (Wycombe)


Bennett, Dr. Reginald (Gosport)
d'Avigdor-Goldsmid,Maj.-Gen. Jack
Hall-Davis, A. G. F.


Benyon, W.
Dean, Paul
Hamilton, Michael (Salisbury)


Berry, Hn. Anthony
Digby, Simon Wingfield
Hannam, John (Exeter)


Biffen, John
Dixon, Piers
Harrison, Brian (Maldon)


Biggs-Davison, John
Dodds-Parker, Sir Douglas



Boardman, Tom (Leicester, S.W.)
Drayson, G. B.
Harrison, Col. Sir Harwood (Eye)


Body, Richard
du Cann, Rt. Hn. Edward
Haselhurst, Alan


Boscawen, Hn. Robert
Dykes, Hugh
Hastings, Stephen


Bowden, Andrew
Eden, Rt. Hn. Sir John
Havers, Michael


Braine, Sir Bernard
Edwards, Nicholas (Pembroke)
Hawkins, Paul


Bray, Ronald
Elliot, Capt. Walter (Carshalton)
Hay, John


Brown, Sir Edward (Bath)
Elliott, R. W. (N'c'tle-upon-Tyne,N.)
Heseltine, Michael


Bruce-Gardyne, J.
Emery, Peter
Hicks, Robert


Bryan, Sir Paul
Eyre, Reginald
Higgins, Terence L.


Buchanan-Smith, Alick(Angus,N&amp;M)
Farr, John
Hiley, Joseph


Buck, Antony
Fenner, Mrs. Peggy
Hill, John E. B. (Norfolk, S.)


Bullus, Sir Eric
Fidler, Michael
Hill, James (Southampton, Test)


Burden, F. A.
Finsberg, Geoffrey (Hampstead)
Holland, Philip


Butler, Adam (Bosworth)
Fisher, Nigel (Surbiton)
Holt, Miss Mary


Campbell, Rt.Hn.G. (Moray &amp; Nairn)
Fletcher-Cooke, Charles
Hordern, Peter


Carlisle, Mark
Fookes, Miss Janet
Hornby, Richard


Carr, Rt. Hn. Robert
Foster, Sir John
Hornsby-Smith,Rt.Hn.Dame Patricia


Channon, Paul
Fowler, Norman
Howell, David (Guildford)


Chapman, Sydney
Fox, Marcus
Howell, Raiph (Norfolk, N.)


Chataway, Rt. Hn. Christopher
Galbraith, Hn. T. G. D.
Hunt, John


Chichester-Clark, R.
Gardner, Edward
Hutchison, Michael Clark


Clark, William (Surrey, E.)
Gibson-Watt, David
Iremonger, T. L.


Clarke, Kenneth (Rushcliffe)
Gilmour, Ian (Norfolk, C.)
Irvine, Bryant Godman (Rye)


Clegg, Walter
Glyn, Dr. Alan
James, David




Jenkin, Patrick (Woodford)
Neave, Airey
Stanbrook, Ivor


Jessel, Toby
Nicholls, Sir Harmar
Stewart-Smith, Geoffrey (Belper)


Johnson Smith, G. (E. Grinstead)
Noble, Rt. Hn. Michael
Stodart, Anthony (Edinburgh, W.)


Jones, Arthur (Northants, S.)
Normanton, Tom
Stokes, John


Jopling, Michael
Onslow, Cranley
Stuttaford, Dr. Tom


Joseph, Rt. Hn. Sir Keith
Oppenheim, Mrs. Sally
Sutcliffe, John


Kaberry, Sir Donald
Orr, Capt. L. P. S.
Tapsell, Peter


Kellett-Bowman, Mrs. Elaine
Page, Rt. Hn. Graham (Crosby)
Taylor, Sir Charles (Eastbourne)


Kimball, Marcus
Page, John (Harrow, W.)
Taylor,Edward M.(G'gow,Cathcart)


King, Evelyn (Dorset, S.)
Parkinson, Cecil
Taylor, Frank (Moss Side)


Kirk, Peter
Percival, Ian
Taylor, Robert (Croydon, N.W.)


Kitson, Timothy
Pike, Miss Mervyn
Tebbit, Norman


Knight, Mrs. Jill
Pink, R. Bonner
Temple, John M.


Knox, David
Pounder, Rafton
Thatcher, Rt. Hn. Mrs. Margaret


Lamont, Norman
Powell, Rt. Hn. J. Enoch
 Thomas, John Stradling (Monmouth)


Lane, David
Price, David (Eastleigh)
Thomas, Rt. Hn. Peter (Hendon, S.)


Langford-Holt, Sir John
Proudfoot, Wilfred
Thompson, Sir Richard (Croydon, S.)


Le Marchant, Spencer
Pym, Rt. Hn. Francis
Tilney, John


Lewis, Kenneth (Rutland)
Quennell, Miss J. M.
Trafford, Dr. Anthony


Lloyd, Ian (P'tsm'th, Langstone)
Raison, Timothy
Trew, Peter


Loveridge, John
Ramsden, Rt. Hn. James
Tugendhat, Christopher


McAdden, Sir Stephen
Rawlinson, Rt. Hn. Sir Peter
Turton, Rt. Hn. Sir Robin


MacArthur, Ian
Redmond, Robert
Van Straubenzee, W. R.


McCrindle, R. A.
Reed, Laurance (Bolton, E.)
Vaughan, Dr. Gerard




Vickers, Dame Joan


McLaren, Martin
Rees, Peter (Dover)
Waddington, David


Maclean, Sir Fitzroy
Rees-Davies, W. R.
Walder, David (Clitheroe)


McMaster, Stanley
Renton, Rt. Hn. Sir David
Walker, Rt. Hn. Peter (Worcester)


Macmillan,Rt.Hn.Maurice(Farnham)
Rhys Williams, Sir Brandon
Walker-Smith, Rt. Hn. Sir Derek


McNair-Wilson, Michael
Ridley, Hn. Nicholas
Wall, Patrick


McNair-Wilson, Patrick (New Forest)
Rippon, Rt. Hn. Geoffrey
Walters, Dennis


Maddan, Martin
Roberts, Wyn (Conway)
Ward, Dame Irene


Madel, David
Rodgers, Sir John (Sevenoaks)
Warren, Kenneth


Marten, Neil
Rossi, Hugh (Hornsey)
Weatherill, Bernard


Mather, Carol
Rost, Peter
Wells, John (Maidstone)


Maude, Angus
Royle, Anthony
Wiggin, Jerry


Maudling, Rt. Hn. Reginald
Russell, Sir Ronald
Wilkinson, John


Mawby, Ray
Scott-Hopkins, James
Winterton, Nicholas


Maxwell-Hyslop, R. J.
Shaw, Michael (Sc'b'gh &amp; Whitby)
Wolrige-Gordon, Patrick


Meyer, Sir Anthony
Shelton, William (Clapham)
Wood, Rt. Hn. Richard


Mills, Peter (Torrington)
Shersby, Michael
Woodhouse, Hn. Christopher


Miscampbell, Norman
Simeons, Charles
Woodnutt, Mark


Mitchell, David (Basingstoke)
Sinclair, Sir George
Worsley, Marcus


Moate, Roger
Skeet, T. H. H.
Wylie, Rt. Hn. N. R.


Money, Ernie
Smith, Dudley (W'wick &amp; L'mington)
Younger, Hn. George


Monks, Mrs. Connie
Soref, Harold



Monro, Hector
Speed, Keith
TELLERS FOR THE AYES:


Morgan-Giles, Rear-Adm.
Spence, John



Mudd, David
Sproat, Iain
Mr. Tim Fortescue and Mr. Oscar Murton.


Nabarro, Sir Gerald
Stainton, Keith





NOES


Abse, Leo
Clark, David (Colne Valley)
Edwards, Robert (Bilston)


Allaun, Frank (Salford, E.)
Cocks, Michael (Bristol, S.)
Edwards, William (Merioneth)


Archer, Peter (Rowley Regis)
Cohen, Stanley
Ellis, Tom


Armstrong, Ernest
Concannon, J. D.
English, Michael


Ashley, Jack
Corbet, Mrs. Freda
Evans, Fred


Ashton, Joe
Cox, Thomas (Wandsworth, C.)
Ewing, Harry


Atkinson, Norman
Crawshaw, Richard
Fernyhough, Rt. Hn. E.


Bagier, Gordon A. T.
Cronin, John
Fisher, Mrs. Doris(B'ham,Ladywood)


Barnes, Michael
Crosland, Rt. Hn. Anthony
Fletcher, Raymond (Ilkeston)


Barnett, Joel (Heywood and Royton)
Crossman, Rt. Hon. Richard
Fletcher, Ted (Darlington)


Baxter, William
Cunningham, Dr. J. A. (Whitehaven)
Foot, Michael


Beaney, Alan
Dalyell, Tam
Ford, Ben


Bennett, James(Glasgow, Bridgeton)
Davidson, Arthur
Forrester, John


Bidwell, Sydney
Davies, Denzil (Lianelly)
Fraser, John (Norwood)


Bishop, E. S.
Davies, G. Elfed (Rhondda, E.)
Freeson, Reginald


Blenkinsop, Arthur
Davies, Ifor (Gower)
Galpern, Sir Myer


Boardman, H. (Leigh)
Davis, Clinton (Hackney, C.)
Garrett, W. E.


Booth, Albert
Davis, Terry (Bromsgrove)
Gilbert, Dr. John


Boothroyd, Miss B. (West Brom.)
Deakins, Eric
Ginsburg, David (Dewsbury)


Bottomley, Rt. Hn. Arthur
de Freitas, Rt. Hn. Sir Geoffrey
Golding, John


Boyden, James(Bishop Auckland)
Delargy, Hugh
Gordon Walker, Rt. Hn. P. C.


Broughton, Sir Alfred
Dell, Rt. Hn. Edmund
Gourlay, Harry


Brown, Hugh D. (G'gow, Provan)
Dempsey, James
Grant, George (Morpeth)


Buchan, Norman
Doig, Peter
Grant, John D. (Islington, E.)


Buchanan, Richard (G'gow, Sp'burn)
Dormand, J. D.
Griffiths, Eddie (Brightside)


Butler, Mrs. Joyce (Wood Green)
Douglas, Dick (Stirlingshire, E.)
Grimond, Rt. Hn. J.


Campbell, I. (Dunbartonshire, W.)
Douglas-Mann, Bruce
Hamilton, James (Bothwell)


Cant, R. B.
Driberg, Tom
Hamilton, William (Fife, W.)


Carmichael, Neil
Duffy, A. E. P.
Hamling, William


Carter, Ray (Birming'm, Northfield)
Dunn, James A.
Hannan, William (G'gow, Maryhill)


Carter-Jones, Lewis (Eccles)
Dunnett, Jack
Hardy, Peter


Castle, Rt. Hn. Barbara
Edelman, Maurice
Harper, Joseph







Harrison, Walter (Wakefield)
McNamara, J. Kevin
Rowlands, Ted


Hart, Rt. Hn. Judith
Mahon, Simon (Bootle)
Sandelson, Neville


Healey, Rt. Hn. Denis
Mallalieu, J. P. W. (Huddersfield, E.)
Sheldon, Robert (Ashton-under-Lyne)


Heffer, Eric S.
Marquand, David
Shore, Rt. Hn. Peter (Stepney)


Horam, John
Marsden, F.
Short, Mrs. Renée (W'hampton, N.E.)


Houghton, Rt. Hn. Douglas
Mason, Rt. Hn. Roy
Silkin, Rt. Hn. John (Deptford)


Howell, Denis (Small Heath)
Mayhew, Christopher
Silkin, Hn. S. C. (Dulwich)


Huckfield, Leslie
Meacher, Michael
Sillars, James


Hughes, Rt. Hn. Cledwyn (Anglesey)
Mellish, Rt. Hn. Robert
Silverman, Julius


Hughes, Mark (Durham)
Mendelson, John
Skinner, Dennis


Hughes, Robert (Aberdeen, N.)
Mikardo, Ian
Small, William


Hughes, Roy (Newport)
Millan, Bruce
Smith, Cyril (Rochdale)


Irvine, Rt. Hn. Sir Arthur (Edge Hill)
Miller, Dr. M. S.
Smith, John (Lanarkshire, N.)


Janner, Greville
Milne, Edward
Spearing, Nigel


Jay, Rt. Hn. Douglas
Mitchell, R. C. (S'hampton, Itchen)
Spriggs, Leslie


Jeger, Mrs. Lena
Molloy, William
Stallard, A. W.


Jenkins, Hugh (Putney)
Morgan, Elystan (Cardiganshire)
Steel, David


John Brynmor
Morris, Alfred (Wythenshawe)
Stoddart, David (Swindon)


Johnson, Carol (Lewisham, S.)
Morris, Charies R. (Openshaw)
Strauss, Rt. Hn. G. R.


Johnson, James (K'ston-on-Hull, W.)
Morris, Rt. Hn. John (Aberavon)
Summerskill, Hn. Dr. Shirley


Johnson, Walter (Derby, S.)
Murray, Ronald King
Swain, Thomas


Jones, Barry (Flint, E.)
Oakes, Gordon
Thomas,Rt.Hn.George (Cardiff,W.)


Jones, Dan (Burnley)
Ogden, Eric
Thomas, Jeffrey (Abertillery)



O'Halloran, Michael



Jones, Gwynoro (Carmarthen)
O'Malley, Brian
Tinn, James


Jones, T. Alec (Rhondda, W.)
Oram, Bert
Tomney, Frank


Kaufman, Gerald
Orbach, Maurice
Tope, Graham


Kelley, Richard
Orme, Stanley
Torney, Tom


Kinnock, Neil
Oswald, Thomas
Tuck, Raphael




Urwin, T. W.


Lambie, David
Paget, R. T.
Varley, Eric G.


Lamborn, Harry
Palmer, Arthur
Wainwright, Edwin


Lomond, James
Pannell, Rt. Hn. Charles
Walden, Brian (B'm'ham, All Saints)


Latham, Arthur
Parker, John (Dagenham)



Lawson, George
Parry, Robert (Liverpool, Exchange)
Walker, Harold (Doncaster)


Leonard, Dick
Pavitt, Laurie
Wallace, George


Lewis, Arthur (W. Ham, N.)
Peart, Rt. Hn. Fred
Watkins, David


Lewis, Ron (Carlisle)
Prentice, Rt. Hn. Reg.
Weitzman, David


Lipton, Marcus
Prescott, John
Wellbeloved, James


Lomas, Kenneth
Price, William (Rugby)
Wells, William (Walsall, N.)


Loughlin, Charles
Probert, Arthur
White, James (Glasgow, Pollok)


Lyon, Alexander W. (York)
Radice, Giles
Whitehead, Phillip


Lyons, Edward (Bradford, E.)
Reed, D. (Sedgefield)
Whitlock, William


McBride, Neil
Rees, Merlyn (Leeds, S.)
Willey, Rt. Hn. Frederick


McCartney, Hugh
Rhodes, Geoffrey
Williams Alan (Swansea, W.)


McElhone, Frank
Roberts, Albert (Normanton)
Williams, Mr. Shirley (Hitchin)


McGuire, Michael
Roberts,Rt.Hn.Goronwy (Caernarvon)
Williams, W.T. (Warrington)


Machin, George
Robertson, John (Paisley)
Woof, Robert


Mackenzie, Gregor
Roderick, Caerwyn E.(Brc'n&amp;R'dnor)
TELLERS FOR THE NOES:


Mackie, John
Rodgers, William (Stockton-on-Tees)



Mackintosh, John P.
Roper, John
Mr. Donald Coleman and Mr. Ernest G. Perry


Maclennan, Robert
Rose, Paul B.



McMillan, Tom (Glasgow, C.)
Ross, Rt. Hn. William (Kilmarnock)

Question accordingly agreed to.

Mr. Alison: I beg to move Amendment No. 2, in page 2, line 19, at end insert:
'(f) such other services as are required for the diagnosis and treatment of illness;'.
This amendment is the result of the further consideration which my right hon. Friend undertook to give to the wording of Clause 2(2) in the light of the discussion in Committee, and particularly the remarks by the right hon. Member for Deptford (Mr. John Silkin). It gives effect to the undertaking that my right hon. Friend gave by adding to the services that he has a duty to provide to such extent as he considers necessary to meet all reasonable requirements,
such other services as are required for the diagnosis and treatment of illness".
It avoids any impression that there may have been that the health care team is a matter of the services specifically referred to in Clause 2(2). I hope that meets the Opposition's point.

Mr. John Silkin: We are obliged to the Under-Secretary and glad that the undertaking could be resolved in this way.

Amendment agreed to.

Further amendments made: No. 3, in page 2, line 24, leave out subsections (3) and (4).

No. 4, in page 2, line 37, leave out 26' and insert '27'.

No. 5, in page 2, line 38, leave out from '1968' to 'relate' in line 39 and insert '(which'.

No. 6, in page 3, line 1, leave out subsection (6).—[Mr. Alison.]

Clause 3

MEDICAL AND DENTAL SERVICE FOR PUPILS

Mr. Lamborn: I beg to move Amendment No. 122, in page 3, line 34, at end insert:
(4) The Inner London Education Authority shall have power to make such arrangements, for securing the provision of free medical treatment for persons for whom full-time and part-time education is provided by the Authority in pursuance of paragraph (a) of section 41 of the Education Act 1944, as are

necessary for securing that comprehensive facilities for free medical treatment are available to them'.

Mr. Deputy Speaker: With the amendment we will take Amendment No. 123, in page 3, line 43, leave out 'Education Act' and insert 'said Act of'.

Mr. Lamborn: The object of the amendment is to ensure that students in the inner London area will be able to continue to receive the valuable supporting medical services that they at present receive under the co-ordinated service run by the Inner London Education Authority.
The Bill recognises the special needs of university health services, which are to be allowed to continue to provide a comprehensive service for students. All the reasons that could be advanced for a university health service can equally be made for the ILEA area, with the tremendous concentration in central London with, because they are concentrated in a great city, possibly greater stresses and tribulations than in other places.
The amendment seeks only to establish what has been recognised in the past, that there is a need for the Inner London Education Authority to provide this comprehensive service for the students in its care. If it does not continue under the control of the authority, under the arrangements in the Bill, the present coordinated service will be split between the various area authorities. This alone is a special reason why the excellent co-ordinated service provided by the authority should be allowed to continue.
It was suggested by a Government spokesman in another place that it might be necessary eventually to return to the avenue of a local act, which is how certain of the present ILEA powers were derived to meet the special needs of students in London. I invite the Secretary of State to say that he is now prepared to recognise those special needs by accepting the amendment.

Mr. Alison: The amendment seeks to secure that the Inner London Education Authority can continue to make such arrangements as are necessary to secure a free treatment service for students of any age attending ILEA further education establishments, including colleges of


education. While the Government appreciate the desire of ILEA to safeguard the health of ILEA students, it would be entirely contrary to the principle of a unified health service for the authority or any other education authority to have power to provide general medical services outside the National Health Service.
I can give the hon. Member for Southwark (Mr. Lamborn) the assurance, however, in response to his eloquent plea, that a service is being brought into being by the authority. I can give on my right hon. Friend's behalf an assurance that the student health centres as existing on 1st April 1974 will be taken over and the scope and range of medical services being provided from them will be maintained by the National Health Service. Thus, the salaried doctors employed by the authority would be retained and taken over by the area health authority on their existing terms of service and with their existing duties.
I hope that, with that undertaking, the hon. Members and his right hon. Friends will feel that we have given all the assurances necessary to safeguard the reality of the service that ILEA is now bringing into existence.

Mr. Lamborn: I have no doubt that if the education authority is dissatisfied with the formula it will endeavour to promote a Private Bill at a later date. In view of the undertakings given by the Under-Secretary, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 4

FAMILY PLANNING SERVICE

10.30 p.m.

Mr. John Stokes: I beg to move, Amendment No. 7, in page 4, line 1, leave out Clause 4.

Mr. Deputy Speaker (Sir Robert Grant-Ferris): With this amendment we are to take Amendment No. 127, in page 4, line 7, leave out from 'and' to end of clause and insert:
'such arrangements shall provide that no charge shall be made for any such medical examination or treatment or for the supply of any such substances or appliances'.

and Amendment No. 128, in page 4, line 11, at end insert:
'save that the Secretary of State shall ensure that no such prescription charges are made in any Area Health Authorities where a local health authority was at the time of passing of this Act already providing a family planning service free of charge for all advice and supplies'.
I should say at this stage that Mr. Speaker has authorized me to say that he will be prepared to grant a division if required on Amendments No. 127 and 128.

Sir George Sinclair: On a point of order, Mr. Deputy Speaker. Am I to understand that we are to have a separate division on Amendment No. 128? Hon. Members have received a number of representations from the public on this particular issue and we should be very grateful if it were isolated from the other issues.

Mr. Deputy Speaker: I am sorry if I did not make myself clear. I thought that that was what I said. There should be a division if required on Amendments No. 127 and 128.

Mr. Stokes: I do not wish to weary the House by a repetition of the arguments about the clause that I used on Second Reading and in Committee, but as tonight will be the last occasion on which we shall have an opportunity to discuss what the clause involves, which is the provision of contraceptives by the State, it is important that we shall all be aware of exactly what the clause means.
I know that my right hon. Friend the Secretary of State and his supporting Ministers are men of the highest integrity and that the last thing that they desire is any lowering of moral standards. But that, I fear, will be the inevitable consequence if the clause is passed as it stands. I also respect the views—although I think that they are mistaken—of what I call the population or birth control lobby, who believe that population control in this country is of such vital importance that it must be achieved, whatever the cost and at whatever moral peril.
I believe, however, that the views that I am attempting to express, while they have not been voiced by the leaders of the church for reasons best known to themselves, are shared by millions of


ordinary people who are Christians or who at least still respect the Christian ethic.
The effect of the clause is that anyone, married or single, can ask for contraceptives to be supplied by their doctor at the normal prescription charge. Had this arrangement really been family planning, as the clause is headed, planning for married people for true families, I should not have raised any personal objection. But because the clause includes single people it makes nonsense of the heading "family planning"—in this case a euphemism for contraceptives for all.
I ask the House to consider whether this is an activity which should be the concern of the State. Many people will say—indeed, many people have told me—that individuals who wish to commit fornication should pay for the contraceptives themselves. The moral argument is the most important. It is to that that I intend to address my remarks.
Surely if the State can no longer uphold a Christian ideal, an ideal adhered to for many centuries in England—I mean chastity before marriage and faithfulness within marriage—at least one would expect the State to be neutral. If the State is to provide a service as in this case, surely the State is also condoning the use of it, and taxpayers' money will certainly underpin it.
Who is to condemn what the State makes available at nominal charge to all and sundry? I believe that this is a most dangerous extension of State activity into the realms of private morals and it is bound to strike a deadly blow at parents, teachers, clergy, youth workers, and so on, who are trying to inculcate Christian moral standards.
On top of the enormous commercial pressures which we all recognise and of all the advertising on television, in magazines and newspapers, plays and films, we now have the State jumping on the bandwagon and implying that sexual intercourse with any partner is a free-for-all activity—normally, natural and, of course, State-aided. [Laughter.] At least the events of the past few weeks should have made the Government more cautious—[Laughter]—in providing for this vast new extension to the permissive society.
If we are to demand higher moral standards from our leaders, what are the Government doing making contraceptives available so cheaply to anybody who asks for them? Can this be what the Government want or what the doctors want or even what some of the powerful birth control lobbies want, unless they are determined to try to destroy the Christian ethic in England which some people appear tonight to find amusing?
It is not often in the House that one can date the beginning of a disaster in history. If this legislation goes through unamended, we may unfortunately be able to say that that was the moment finally when England gave up being a Christian land.
Instead of the Government checking the permissive society with all the authority and all the influence which they have at their disposal, they have decided to go with the stream, to take the line of least resistance. I predict much misery to many families and, worse still, much damage to the institution of marriage as a result of the clause. Not least would it harm the women of this country. We should not be mealy mouthed about this. Abortion, venereal disease, divorce and other evils will, I fear, flourish to an even greater extent than now if the clause goes through unamended. Once the Government allow sexual intercourse for all, virtually paid for by the State, we shall see an end to our society, based as it has been for so long on the unit of the family.
I therefore call on hon. Members on both sides of the House to share my views and my fears and to support my amendment. At least we should ask the Government to think again and make these services available only for family planning and not for single people. I certainly propose to divide the House.

Mr. Pavitt: I do not wish to address myself to the debate which has been initiated by the hon. Member for Oldbury and Halesowen (Mr. Stokes) because no doubt the Secretary of State will deal with that adequately when he speaks. I wish to devote my speech to the amendment standing in my name, and I welcome that the Chair has permitted a vote on the third amendment. For my part, although that amendment does not go far enough, I shall be a supporter of the


hon. Member for Norwich, South (Dr. Stuttaford) in the Division Lobby when we reach that stage.
But because we have debated this matter at great length on Second Reading and in Committee the order of the night must be brief speeches, and because this is such an important matter I do not see why I should not also be brief. Therefore, I hope that the hon. Member for Oldbury and Halesowen will forgive me if I do not take up the remarks he made. The arguments are well known and the sooner we reach a decision the better. Most of us will know how much this decision interlocks with so many other aspects of the health service. Every debate we have had on the Bill has been related to matters raised in other debates.
My amendment is designed to provide for free counselling, appliances, and education. In Committee by a very narrow margin the Secretary of State, almost by accident, managed to get a compromise through which will mean that the provision of medication, the provision of appliances, of intra-uterine devices, will now be subject to prescription charges. To counter this step in the wrong direction I hope that my amendment will be accepted. The imposition of prescription charges will create the very problems that the clause is seeking to deal with. Those problems include abortion, illegitimacy and unwanted children being born. There is adequate evidence of free supplies leading to more counselling, and the object of the exercise is to provide a comprehensive family planning service which will attract people who would not normally receive advice.
In London 19 out of 32 boroughs are already doing that. The whole sphere of social problems is affected by this. It is not just a question of family planning and whether or not unwanted children are borne. There is also the question of population control, which I know concerns many hon. Members on both sides of the House.
10.45 p.m.
The right hon. Gentleman has had a barrage of demands from all quarters for a completely comprehensive free service—from the Association of Municipal Corporations, from professors of teaching hospitals, and from doctors, especially

obstetricians and gynaecologists. The British Medical Journal of 7th April made it quite clear in a leader that on medical grounds the introduction of a prescription charge is a step in the wrong direction.
The debate is about preventive medicine, not treatment for illness. There is nothing ill in sex or having babies. They are natural functions. Every other immunisation service under the health service is free. We do not charge for jabs to prevent polio, for cervical smears, for chest X-rays. We try to prevent problems. Precisely the same should apply to family planning. It is a question not just of health but of trying to prevent problems in the community, which can be achieved by the comprehensive extention of family planning advice services.
The right hon. Gentleman made the change in Committee to save £3 million. In fact, he will not save even £1 million of that. A cost-benefit analysis would show that not only will the health service not save £3 million but that there will be a debit of £2 million or £3 million to be met by the taxpayer as a result of other social problems. By imposing a prescription charge the right hon. Gentleman is shelving problems for his Department but putting problems on to other social services, other Departments and the community at large.
I beg the right hon. Gentleman to accept the amendment. It is nonsense to impose prescription charges. It is nonsense in logic, organisationally, administratively, socially and clinically. It is sheer nonsense to ask doctors to do this kind of thing, distorting the whole family doctor service. The right hon. Gentleman will receive a demand for fresh contractual arrangements in the service.
If the right hon. Gentleman is not big enough to accept the position as it was in the other place, and although there is a free vote tonight, I urge all hon. Members on both sides to support the amendment, which seeks a humane and constructive approach to a serious social problem.

Dr. Stuttaford: I am grateful that we are to be allowed a separate Division on Amendment No. 128, an important amendment standing in my name and that of my hon. Friend the Member for


Hampstead (Mr. Geoffrey Finsberg). It is important because we are trying not to do anything new but to preserve a service that has already been set up. In most places where it is working it has been going for two years, and in some cases as many as six.
If the House does not adopt our amendment we shall be scrapping that service in its existing form. We shall be changing it. That is something we never hoped to see any Conservative Government do. We never hoped to see ourselves go backwards.
It is particularly unfortunate when my right hon. Friend the Secretary of State has done so much for family planning. From a figure of £750,000 three years ago, the expenditure on family planning is to rise to £30 million. Yet we are to go back by £500,000. We are taking 60 paces forward and are to take one pace backwards. It is that one pace that will be remembered by everybody. It will be counter-productive in regard to all the advertising for contraception or for planned families.
It is axiomatic in medicine that we must set out not only to do good but to avoid doing harm. If tonight we curtail the services provided by the 33 local authorities that today provide them free, we shall be doing harm and going backwards. The services which have been provided have proved of benefit to the community. From such pilot schemes, information has been collected which shows that we are getting through to the people we have to get through to if we are to have an all-embracing family planning services.
It is often said that we will not get Social Class V along to the family planning clinics, but in the areas where a free service has been instituted, the number of people from Social Class V attending has doubled in the first quarter. It is also often said that if one starts a service in a new area one is bound to get people attending it who are dissatisfied with the service in the neighbouring area and will, in effect, be providing a service for those no longer prepared to pay. But this in practice has been shown not to be the case. The great majority going to local authority clinics for the first time are in fact having contraceptive advice for the first time. This is a matter not

just of supplies but of counselling, of discussion with the doctor. It is an advice service as well.
Aberdeen is a city close to the heart of my right hon. Friend. He has poured scorn on its figures.

The Secretary of State for Social Services (Sir Keith Joseph): I have paid particular respect to Aberdeen. I allowed myself some criticism of the author of the pamphlet about Aberdeen.

Dr. Stuttaford: There is a very subtle difference. The author got the figures from the Medical Officer of Health of Aberdeen, who is known to be in favour of the amendment, together with many other outside bodies. He is in favour because Aberdeen has found that, although it had an extensive service previously, when it started the free service in 1967 many people came forward who had not come forward before. Indeed, the number doubled. For example, many women who were at risk in childbirth came forward and pregnancies among such women dropped by one-third. That is very important. Medicine is a matter not only of prevention but of cure in this context. Here the two are combined. Aberdeen also found that Social Class V people came forward. No wonder the medical officer of health is enthusiastic for the amendment. He is enthusiastic because he has not just thought about this in Whitehall but has actually tried the system and has found that it works.
The other error committed by my right hon. Friend in discussion of future services is the problem of the provision of the male contraceptive, which is a useful, well-tried and effective method. My right hon. Friend's idea is that the male contraceptive should be prescribed by the general practitioner. Anyone involved in medicine knows that that will not work. It may seem a splendid idea when viewed from an office desk, but it will not work in the surgery. Men who need this method will not come into the surgery to queue up alongside people suffering from coughs, colds and varicose veins. Nor will general practitioners prescribe the male contraceptive. They say that this is not what they trained eight years to do. This is something more commercial, requiring very little skill. It is not like prescribing other forms of contraceptives. It is not a life or death decision such as prescribing the Pill can be.
It is just an administrative method thought up in Whitehall that bears no relevance at all to what is going on in the surgery. On the other hand, it is right and proper that this should be provided easily. If the GPs are not to provide this, and they are not, who will? The answer is those clinics which, if we do not carry this amendment, are in danger of having their services curtailed.
These clinics can provide and are providing this service. We should be encouraging them to provide even more. We should do our best to see that this method is prescribed more widely, but not prescribed by the GP. It should he prescribed by those not necessarily medically qualified in the centres and clinics. If we look at the situation today and at what we want to do we must think carefully before we undo what has been done by those 33 boroughs. This is something which we may all regret because no one knows the impact of a charge on contraceptives in these clinics.
We do know the impact, those of us who have worked in the field, of any other form of prescription charge. I have practised medicine without prescription charges and with them. I have been even more fortunate; I have done it with, without and with again. There is no doubt in my mind that even a trivial charge acts as a deterrent. This is an area of medicine in which we should not be deterring anyone. We should be advertising it, doing our best to get people to have the right size family for their homes, themselves, their community and their country. If we put obstacles in their way, even apparently trivial obstacles to those well provided for, financially and intellectually, we may find we are doing everything which we have set out not to do. We shall discourage people from using the service, and I for one am not prepared to take any part at all in discouragement of this type.

Mr. Robert Hughes: The hon. Member for Oldbury and Halesowen (Mr. Stokes) made great play of the fact that in his view the decision of the National Health Service to become responsible for family planning services is some derogation from the moral standards of our society. I must tell him that his experience and knowledge of what happens in illegitimate pregnancies is non-existent and naive. The vast

number of illegitimate pregnancies are the result of casual sexual encounters. The majority of unmarried couples who consult family planning services have a stable relationship and often marry at a later stage.
The decision of unmarried people to consult family planning services is a matter of responsibility. The service does not hand out some requisite and say "goodbye." It gives advice. I regard the use of contraceptives, whether supplied by the State or anyone else, as being the antithesis of what the hon. Member would call the permissive society. I believe that this is the view prevalent throughout the country.
There is no doubt that the decision take by the House on Amendments Nos. 127 and 128 will have a profound effect on the position in Scotland. Section 8 of the National Health Service (Scotland) Act 1972 is more widely drawn than is Clause 4 of this Bill, but even so I frankly doubt very much whether the Government will permit a different scheme in Scotland from that adopted in England and Wales.
11.0 p.m.
I think it is necessary that the House should be aware, and I hope it will be, of the Scottish experience in family planning.
I have some relevant information to give, having been convener of the health and welfare committee in Aberdeen when it embarked on establishing a free family planning service, and from that I know the difficulties in selling this to the public—the feeling that sex is to be supplied on the rates, and that kind of extravagant claim which has been made. Such claims have been faced.
All Members, I think, have seen "The Benefits of Birth Control: Aberdeen's Experience, 1946–1970". Time does not permit me to quote extensively from it, but there are one or two items of information which I would mention and which I regard as important. The infant mortality rate in Aberdeen dropped from 19·2 per 1,000 live births in 1965 to 14·5 in 1970, and further reduced to 12·3, one of the lowest mortality rates in the world.
Another point is this. There were no maternal mortalities in 1969 or 1970. As we mentioned earlier, high-risk pregnancies have been greatly reduced, and


the position is that in pregnancies to women aged 35 or more the risk has been reduced from 9·3 per cent. in 1961 to 4·8 per cent. in 1970. The report says:
The rate of high risk births to mothers of large families was also reduced to 7·4 per cent. by 1969, about half the rate for Scotland as a whole.
For example, the rate for Glasgow was 24 per 100 live births in 1969.
I am not suggesting that was all due solely to a comprehensive family planning service, because there has been great co-operation between the local authorities' health services and the regional hospital boards, which are now to pass out of existence, but it is also due to the pioneering work in obstetrics and gynaecology of Sir Dugald Baird and, now, Professor McGillvery, and also to improvements in housing and to the health education unit of Dr. MacQueen, the Medical Officer of Health of Aberdeen.
I feel entitled to claim that a service which started in the small way in a central clinic rather hidden from the public's view expanded to peripheral clinics and to the domiciliary services, and so to people who found it difficult to get to the central clinics because of transport difficulties. The costs to those people were extremely important. I shall not quote many statistics because of shortage of time, but in 1970 Aberdeen had approximately 37,400 women aged between 15 and 44, roughly the child bearing age, and by the middle of 1972 it was estimated that the local authority clinics had given contraceptive help to over 18,000 new clients, nearly half the number of women of child-bearing age in the city. These figures are in the report.
I hope the House will acquit me of immodesty when I say the town council has every reason to be proud of the policy decisions it took at a time when it was not the conventional wisdom to provide a free comprehensive system of family planning. Aberdeen's pioneering experience has not fallen on barren ground. In July 1972 52 out of 56 local authorities in Scotland provided some kind of family planning service. This shows how the whole family planning movement has gone forward. I have a letter for the Central Scottish branch of the Family Planning Association, and it

points out that Glasgow and Renfrew-shire had had a free service for one and two years respectively. The number of new patients increased from 1,802 in 1968 to 5,027 in 1972. In the first quarter of 1973, 1,850 people attended, which is more than the number who attended in the whole of 1968. Using a not very elegant expression, the association says:
Those of lower social classes who were previously deterred by fees now attend. Small as the 20p prescription charge is, it is still enough to prevent them attending for continuous supplies, which is essential for effective family planning.
The association is reaching a number of people who find it difficult to meet their obligations and face their responsibilities.
The case is made out at the very least for the continuation of existing services. It is a great pity that those boroughs in England and Wales which operate comprehensive services are likely to have them eroded. It is a pity that, having grasped the nettle of providing the services and justifying them to the ratepayers, they should now see their work being eroded. They all expected—as we did in Scotland—that the services would be allowed to continue under the new area health boards.
I pay tribute to the Under-Secretary of State for Health and Education, Scottish Office, the hon. Member for Dumfries (Mr. Monro), for his courageous stand in Committee against his own back benchers. I believe that he was sincere in paying tribute to the Scottish local authorities who had done the pioneering work. He gave us good reasons for believing that the best of the services would be allowed to continue in Scotland. When we discussed Clause 8 of the Scottish Bill on Report he said—referring to the hon. Member for Roxburgh, Selkirk and Peebles (Mr. David Steel):
As the hon. Gentleman said, the present responsibilities of the local authorities will be taken over by the health boards, and I have no doubt that areas such as Aberdeen which have very comprehensive family planning clinics at the moment will continue to do so under the health boards."—[OFFICIAL REPORT, 26th July 1972; Vol. 841, c. 1988.]
If the Government override this view, if they compel uniformity throughout the United Kingdom, they will be in breach of faith and break the pledge solemnly


given by the Scottish Office. That cannot be lightly contemplated either by the Government or the House. I hope that, whilst bearing in the mind the experience of England and Wales, the House will be well aware of the profound results the decision today will have on the authorities in Scotland and the excellent work that has been done.

Mrs. Jill Knight: There is virtually unanimous support in the House for responsible family planning, and overwhelming support for the work of the family planning clinics. The argument is about whether the service should be completely free to everyone who asks for it or whether a charge should be made.
I have been shocked by some statements made in the Chamber this evening, because those who have made them know perfectly well that there is absolutely no evidence to prove that more people take advantage of the family planning service if it is free.

Mrs. Renée Short: Yes, there is. Even Birmingham has proved it.

Mrs. Knight: Birmingham has not proved it and neither has anyone else. There are still many areas of grave need within the health service. There are many areas in which money could be better spent than on totally free family planning.
I am strongly in favour of family planning and of every type of contraceptive being free to those who genuinely cannot afford to pay. But it is ridiculous to provide a totally free service and totally free contraceptives to people who can afford to pay for them. It would not be so stupid and wrong if there were not so many other areas of need. I cite only one, and that is the need for more kidney machines. There are people in this country who are dying because there are too few kidney machines. It seems to me quite extraordinary that we should be suggesting a provision which would deny money being spent on that vital matter where the need is so much greater compared with the matter we are now discussing.
I shall make a brief speech, but I am particularly anxious to call my right hon. Friend's attention to a point I made in

Committee relating to the age of consent. As the Bill now stands, with family planning provision coming under the National Health Service, it would mean that although adults paid a prescription charge for contraceptives—unless they could not afford to do so—a child under 16 would be able to obtain these things absolutely free. The age of consent is still valid because it exists for the protection of young people. By passing one new law of this nature we shall make it easier to break another law, and this would lead to an extraordinary situation.
I put this point to my right hon. Friend in Committee, and his answer was:
I should need a practising lawyer to answer that question"—
and the question was whether the law would encourage on the one hand what it forbids on the other. The Secretary of State continued:
The fact is that the Committee is now concerned with unwanted pregnancies. … That is the situation we face. My hon. Friend has asked me a legal conundrum I will look into it, and write to her with the best advice I can obtain."—[OFFICIAL REPORT, Standing Committee G, 17th April 1973; c. 302.]
No doubt due to the heavy burden which my right hon. Friend bears, I have not yet received a reply, but I am sure he will give me a reply this evening.
I regard it as an extremely important point that the law of the land still says that the age of consent is a relevant factor in the protection of young people. Bearing that point well in mind, I would be grateful if my right hon. Friend could answer the question which I posed to him in Committee on that occasion.

Dr. Stuttaford: Before my hon. Friend sits down——

Mr. Deputy Speaker: The hon. Lady has already sat down.

Mr. David Steel: It seems to me extraordinary that many hon. Members are prepared to set at naught the experience of local authorities in various parts of the country in family planning matters. With respect to the hon. Member for Norwich, South (Dr. Stuttaford), I feel that his amendment is second best. We should at least try to prevent the Government going backwards. Therefore, I support the hon. Member for Willesden, West (Mr.


Pavitt) in hoping that we can get the Government to move forward.
It also seems to me extraordinary that many are prepared to set at naught the opinion of the Royal College of Obstetricians and Gynaecologists, which said:
There should be no financial disincentive to the provision of advice and services by any doctor working within the National Health Service.
It seems extraordinary that they are prepared to set at naught the opinion of the British Medical Association that
a national and uniform family planning service should be set up, including the provision of free planning advice and equipment by general practitioners.
It seems extraordinary that they would set at naught the opinion of our own Select Committee on Science and Technology or the view of the Population Panel. All these bodies have gone into this matter a good deal more fully and thoroughly than we have in short debates in this House.
11.15 p.m.
The hon. Member for Oldbury and Halesowen (Mr. Stokes) spoke of the Christian ethic. I and others object strongly when those who hold one view within the Christian ethic appear to hijack unto themselves the Christian ethic to their own point of view. The most recent debate within the Christian denominations on this subject was two weeks ago in the General Assembly of the Church of Scotland, and nobody would accuse the Assembly of being over-adventurous or radical in matters of sex. Yet the Assembly, with the most up-to-date information, discussing precisely the proposal in this Bill, after heated debate and only by a majority, indicated its strong support for the policy of the Government. Therefore, to attempt to remove this proposal on Christian ethic grounds appears to have little support.
As to economies, to suggest that possible revenue from prescription charges estimated at about £3 million could somehow be used to buy kidney machines or something of the kind is extraordinary when one considers expenditure on health and welfare services at present caused by lack of a free family planning service.
A Government policy which produces such odd anomalies as free contraceptives

for old-age pensioners is difficult to defend in logic. Whatever criticism one may have of the detail of the Political and Economic Planning report which said that for every £1 spent on family planning we could save £100 on health and welfare expenditure and I accept what the Minister said on a previous occasion—it is nonsense to talk of economies by making prescription charges for family planning.
Whatever our views on the Medical Termination of Pregnancy Act or abortion generally, we can agree that it is far better to prevent conception than to terminate pregnancies. Whatever our views on the argument on abortion generally, we must be concerned about the dramatic increase in demand for abortion. Yet research shows, as a matter of fact, that time and time again demand for abortion is caused by lack of knowledge and lack of use of birth control provisions.
In 1971 we had 53,000 National Health Service abortions costing £100 each, and the amount accumulated by prescription charges for birth control is trifling by comparison.
I agree with what the hon. Member for Aberdeen, North (Mr. Robert Hughes) said about the experience of that city. The medical officer of health there estimated that for his city the two items of expenditure of £17,000 on contraceptive services and of £18,000 on health visiting and health education represented a total annual saving in rates and taxes of £200,000.
The facts are in favour of the amendment in the name of the hon. Member for Willesden, West, but not only the facts. Reports in the House are in favour and public opinion as shown by National Opinion Poll, at 64 per cent., is in favour of free family planning. The House would be stupid to go against the facts and against public opinion, refusing to accept opinion in favour, and the general demand in the country for a free birth control service.

Mr. Ronald Bell: I support the amendment moved by my hon. Friend the Member for Oldbury and Halesowen (Mr. Stokes). Few things are more important than limitation of the increase of population, and one way to effect that is the inhibition of unwanted conceptions, sometimes grandly


called birth control. That view is probably widely shared by both sides of the House. In supporting my hon. Friend, I can say that I probably advocated this view and pressed it before any other hon. Member at present in the House did so.
In supporting my hon. Friend, I am not withdrawing from my previous support for family planning, as it is conveniently called. Nor am I concerned with proposals for charging, or with whether the advice or the gadget should be supplied free. What is objectionable, in my view, is that the State should provide these appliances and this advice free to unmarried people.
I understand the attitude of those who say that it is possible to draw a clear distinction between making the appliances available and the moral precepts as to how one should behave in the matter of sexual conduct. I have always believed this to be a false distinction and one which cannot be made.
I remember when my friend Sir Alan Herbert, who I helped to return to this House many years ago, propounded the belief that the ease with which people could get out of marriage by divorce would not affect the state of mind with which they entered it. I always believed that to be a fallacy, and experience has amply demonstrated over the past 40 or 50 years that it is a fallacy. By making divorce very easy, we have gradually washed away the great institution of marriage. It is an illustration of hard cases making bad law if, by trying to relieve intolerable hardships, we destroy a very valuable human institution.
Those who advocate the free provision of birth control appliances to unmarried people are saying to themselves that it is possible to do this without encouraging promiscuity because, on the one side, there is the mechanical appliance and, on the other, there are the great moral questions which we can go on discussing.
I do not believe that there is any substantial number of young girls regularly taking the contraceptive pill who are living chastely. It would be nice if it were so, but I do not believe it. Nor does anyone else on either side of the House. The fact is that the two interact.
Then there are some who ask whether it matters, anyway. Is sexual promiscuity

harmful to the community or a form of progress? It is too large a subject to go into at this hour when short speeches will be more appreciated than long ones. But I believe that there is ample evidence gathered by the methods of natural science to prove beyond dispute that sexual promiscuity damages the energy and the morale of a society.
If that be so, it must be wrong that the State, which is the official expression of the voice of us all, should set its imprimatur upon loose and casual sexual encounters. If that be so—and obviously those are the views underlying my own attitude—it would be right to make these appliances generally available free only if there were some countervailing consideration of greater magnitude.
I suppose the one which is put forward is that it will avoid some unwanted births. Inevitably it will, but I suggest that the number will be infinitesimal. It is not lack of money for contraceptives which causes illegitimate births. Nor is it ignorance of the existence of contraceptives. Does anyone seriously think that there will be a wider knowledge of the existence of contraceptives sheaths because they are available freely on the National Health Service? That is absolute nonsense.
Illegitimate births are caused by recklessness, by carelessness, by drunkenness and by incompetence, but never by lack of money to buy the appliances. Looking at the average industrial wage and accepting that it is an average and that there are some above and some below it, still the cost is so trivial that the argument is ridiculous. I find it astonishing when the effect of promiscuity upon the general moral tone of society is put forward as the only argument to counterbalance all the other considerations.
I am glad that my hon. Friend has moved the amendment, because it enables those of us who take that view—I believe if we get away from the fashionable froth, about nine-tenths of hon. Members take that view—to have an opportunity of expressing it in the Lobby tonight.

Mr. Selwyn Gummer: Although sympathising with the attitude expressed by my hon. Friend the Member for Oldbury and Halesowen (Mr. Stokes), I think it is possible for those of us who are Christians to hold different views on contraception, as the


hon. Member for Roxburgh, Selkirk and Peebles (Mr. David Steel) has suggested.
I believe it is difficult to take the line suggested by my hon. and learned Friend the Member for Buckinghamshire, South (Mr. Ronald Bell). If his argument is right, the State should not support homes for unmarried mothers. It is clear that if we make the situation more humane for those who have children out of wedlock, then it might be argued—indeed, our Victorian grandparents and great-grand-parents did argue—that this is an encouragement to promiscuity.
I believe that we should accept that we live in a society which presupposes the existence of contraception. Whether we like it or not, we have a generation which is growing up in that society and we must make our decisions in light of that situation. Therefore, there is no argument between most hon. Members on both sides, however strongly we may feel about pre- or extra-marital sex, about the need for a contraception service.
The real question is whether making that service free actually increases the number of people who will use it. I submit that that argument has not been carried by those who have put it forward.
The hon. Member for Roxburgh, Selkirk and Peebles repeated several times that it was important to see that the largest number of people possible use the contraceptive service. However, I do not believe that he adduced any evidence to show that a free contraceptive service will increase the number of people who use it.

Mr. David Steel: rose——

Mr. Pavitt: rose——

Mr. Robert Hughes: rose——

Dr. Stuttaford: rose——

Mr. Gummer: In view of the plethora of attempted interventions, I think it would be fair if I refused everybody.

Mr. Steel: rose——

Mr. Gummer: As I mentioned the hon. Member for Roxburgh, Selkirk and Peebles, perhaps it is fair to give way to him.

Mr. Steel: As evidence may I cite the medical officer of health for Lincoln,

writing in the British Medical Journal earlier this year:
the case for free family planning services is overwhelming. The local authority family planning service became completely free in September 1972, and the number of women attending in the first quarter was twice the average for the previous four quarters. This proves that although the cost of supplies may appear to be insignificant, it is indeed a disincentive to many women, and particularly many of the women whose needs are greatest.

Mr. Gummer: The hon. Gentleman does not mention that the medical officer of health for Lincoln could have pointed to the large increase in advertising of the service which accompanied that change. That is a totally unfair piece of evidence. That is an opinion by an individual medical officer of health.

Mr. Robert Hughes: rose——

Mr. Pavitt: rose——

Mr. Gummer: I must continue. It is only fair to try to make one's speech as short as possible at this time of night. The only so-called evidence put forward has been the opinion of a number of eminent and worthy people, but the opinion of a number of equally eminent and worthy people to the opposite effect was cited in Committee.

Dr. Stuttaford: There is some confusion between opinion and numbers. Will my hon. Friend consider the situation in Brent, where there was little, if any, advertising? In fact, a deliberate attempt was made to keep the service rather quiet. Yet, despite that, there was a 68 per cent. increase in new attendances in the first six months. Does he consider that that was entirely due to the almost non-existence of advertising or to the free service provided?

Mr. Gummer: My hon. Friend's figure for Brent would be more effective if it were not a percentage but numbers. I am sure that he would like to tell me later exactly what the numbers were.
It is reasonable to suggest that there is no evidence that a free contraceptive service, but for a small payment for a prescription, increases the number of people who attend those clinics.
11.30 p.m.
Those of us who feel strongly, as does my hon. Friend the Member for Oldbury and Halesowen, against abortion, must


be the first to be in favour of the widest contraceptive service. I would ask him to think again, when we come to decide on his Amendment, whether it is not much better to have a service of contraception throughout the country which will reduce the number of abortions rather than have the appalling incidence of abortion that we have at the moment.
I am very much, I might almost say enthusiastically, in favour of a widespread contraception service because I believe that abortion is much more unacceptable. Those of us who think that should think very carefully before we refuse to have the kind of contraception service that the Secretary of State's proposals would provide.
But the real issue is that, if it is true that doctors believe that there is no need for them to prescribe male contraceptives, we have to look carefully at the argument of my hon. Friend the Member for Norwich, South (Dr. Stuttaford) that doctors would feel that this was merely a dispensing service. I apologise for saying so, since my hon. Friend is a doctor, but it seems a very narrow view of medicine to say that a doctor is not prepared to accept that the opportunity to prescribe male contraceptives is a similar opportunity to that of providing—this entails much more difficult and complicated decisions—female contraceptives. As he and others have said, the provision of contraception is not as easy as that, but has very important effects upon the psychology of the person concerned. I hope that my hon. Friend's colleagues will take this opportunity to give the kind of proper medical service that many of us feel is not merely the prescription of pills but actually being concerned with the whole individual.

Dr. Stuttaford: Would my hon. Friend agree that I said that the clinics can well provide these male contraceptives and that doctors may recommend their patients to go to the clinics to get them? He surely would not expect GPs month after month to count out Durex to hand to patients. That would be unrealistic. It is reasonable that there should be a consultation and a recommendation, but the actual dispensing is not a reasonable request.

Mr. Gummer But: if my hon. Friend believes that it is beyond the wit of the medical profession to organise in this

respect the kind of regular and repeated prescriptions which arise over a number of chronic illnesses, he underestimates his colleagues. It is possible for them to do this.
The whole contraceptive service, like other kinds of preventive medicine, should be within the National Health Service. It is unacceptable to suggest that another £3 million does not matter, when many of us, on behalf of our constituents, have been fighting for much smaller sums for the improvement of health service provision. Perhaps hon. Members are not happy with the example of the kidney machine, but I should be much happier if that £3 million were spent on extra-domiciliary services, with more money on advertising, in a greater endeavour to reach those people who at the moment are not reached by contraceptive services than the mere provision of this free service for which no evidence has been adduced save the individual opinions of some people.
If this is so, those hon. Members who rightly have a strong view about the sanctity of marriage and the whole nature of the use of sex should think carefully about the extra abortions to which the policy they advocate leads. On the other hand, those who really believe—and there are many on this side of the House—that the small prescription charges levied in the case of life and death drugs would be so much of a deterrent in the case of contraception that they cannot be levied in that case should think again and wonder whether that £3 million would not much better be spent on advertising and better domiciliary services or elsewhere in the National Health Service, in order to ensure that we are not guilty of throwing away that money merely because of the unsupported evidence of the opinions of one or two.

Mr. Leo Abse: It had not been my intention to intervene in this debate, whose subject matter was amply ventilated at an earlier stage, but, listening to it, I am prompted to intervene—even if only for a few minutes—because, although I have heard a great deal about birth control, contraceptive services, the sexual habits of the nation, promiscuity, the expertise of abortion, and some profound comments about the etiology of illegitimacy from at least one hon. Member, I have heard extraordinarily


little about what the debate should be about; namely, children.
We sometimes tend to forget that we are talking not about promiscuity but about the consequences that may arise from deep springs and from many other causes than accidents, but which may arise undoubtedly from fecklessness and carelessness of another order.
During the last few months, in speeches of great interest and sensitivity, we have all heard a great deal from the Secretary of State about the cycle of deprivation. No one has emphasised it more, and it would be churlish of anyone on the Labour benches not to pay tribute to the Secretary of State, because he is aware that if we are to deal with the problems that cause hon. Members on both sides of the House so much concern, and if we are to break the concatenation of events whereby the problems of the parents are thrown upon the children, we must tackle the technique of breaking that terrible cycle.
When we already know from our experience of the operation of the Family Planning Act—with which I was early associated—that the most positive benefit that came from that measure was that we were able to reach out, through domiciliary visits, to those who would not otherwise use contraceptives; when we are all thinking, "Can we help in any way to reach out to what we may regard as the poverty-stricken or feckless", I find it quite extraordinary that we are being asked for evidence of the kind that is now being demanded in order to establish that we must do far more if we are to reach those people than we have done up to the present.
What we did in the Family Planning Act was to take contraception away from the barber and from the machines from which it could be bought, in garages and elsewhere, and to begin to drive people into the family planning centres. Anything that we do that turns them back to the barber or the slot machine is fundamentally reactionary, and who can doubt that that is one of the main consequences of what is being suggested in the amendment? Who can doubt that harassed hard-pressed doctors will not be the people who will give supportive advice and guidance to people who go to see

them? Who can doubt that these are not the sorts of people who we are trying to reach—people who will queue in an overcrowded surgery to get a prescription? The effect of this move is bound to be that we will turn people from the clinics, where they were getting free contraceptive appliances and were available to be given advice, back to the barber's shop and the machines?
It is true—I accept the argument that has been presented—that we may be spending too much, and money which could be directed elsewhere, by giving a totally free service. But can anyone doubt that unless we are prepared for this overkill operation we shall not reach that particular section of the community which breeds the large families, in every one of our cities and our constituencies? We well know that certain families will continue having more children than they can manage and support in the centres where it is likely that we get problem children and delinquent children, the problems about which the Secretary of State says that he is most concerned.
The Secretary of State is faced with a challenge tonight to see how he can harmonise all the views that he has put forward about his pre-occupation with the cycle of deprivation when he well knows that as a result of the operation of this scheme he will miss out that section of the community which has to be reached.
I find it sad that the Secretary of State is failing here in doing this. He has done a great deal. This is an extraordinary thing to do. It is not for me to teach the Secretary of State his own politics, but he must know that the result of the debate will be that everyone will regard the Government as reactionary on this issue, as they are in so many respects, even while he can claim rightly that he has done a great deal more in terms of finance than any previous Government. But it will surely go out from this House, as it must, that the right hon. Gentleman is the Secretary of State who has smashed to a large degree the work of the most progressive authorities throughout the country. It will go out that he is hamstringing entirely all the innovating work done in Scotland. It will go out that the right hon. Gentleman is sabotaging the main efforts put forward by those who have been desperately concerned, often


against public opinion, for family planning. The right hon. Gentleman really should reconsider this matter.
If the right hon. Gentleman argues that the evidence does not show this need, robust common sense will tell all of us that if things are free people are more likely to have them and use them. There are very few exceptions to that principle. If we are asked to adumbrate evidence to prove something that is so obvious, the perception of this House is being underestimated.
Even at this late hour I hope that the Secretary of State will have a change of mind. If the right hon. Gentleman will not yield to us, I hope that hon. Members will use their votes in order—I say this to Conservative hon. Members—to save them politically from the opprobrium that is bound to fall on them, to save them from making fools of themselves, as they are, by giving millions of pounds on the one hand but, on the other hand, sabotaging the efforts of all those who have been most concerned about this matter.
Hon. Members must have a sufficient degree of political sophistication to be able to see the dilemma in which the Secretary of State has placed himself. Perhaps together we can save him and the nation from this little folly.

Mr. Geoffrey Finsberg: I am not sure that the speech to which we have just listened particularly helps the case that I want to argue. It tended to bring an unwanted aspect into the debate; namely, political expediency. I am sorry that the speech finished in the way it did.
I make no apology for intervening in the debate, for quite a few reasons. First, what we are asked to debate in these various amendments is a matter of fundamental importance. I want to speak in some detail of a particular authority of which I have knowledge. I need, at least on this occasion, perhaps as on others, to be completely consistent. I want to speak about the London borough of Camden, because I was the leader of the Conservative Party on that council when we implemented, on 11th March 1968, the only free family planning service at that stage that was permitted under existing legislation.
11.45 p.m.
From 11th March 1968 no charge was made to Camden residents for advice or medical examination but a charge, subject to abatement, was made for the supply of requisites prescribed to persons seeking advice on social grounds. Those were the first steps on the issues I want to talk about tonight.
I subsequently became the Leader of Camden Council but gave up that post. I am still a member of the council and of its health committee.
Since 1st January 1972 no charge has been made to Camden residents for family planning supplies or appliances prescribed at the council's family health clinics or at clinics run by voluntary bodies as agents of the council or to Camden residents referred by general practitioners.
I will give figures to my hon. Friend the Member for Lewisham, West (Mr. Selwyn Gummer) and others to show that the introduction of a fully free service—not in percentages, but in numbers—has been justified.
I start by giving some figures in financial terms for the three years in question. In 1970–71 Camden spent £24,000 on family planning, in 1971–72 £37,000 and in 1972–73, the first full year of a fully free service, £67,000. The provisional estimate for the current financial year is £74,800.
The cost of advice and supplies to one woman is about £7 to £8 per annum. The cost of maintaining a child in a day nursery is £400 per annum. The cost of maintaining a child in a residential children's home is £1,800 per annum. Even on a cost benefit basis I submit that a fully free service is completely justified and justifiable.
I will now give some figures in numbers, not percentages. I will again take the three years 1970, 1971 and 1972. In 1970 a total of 11,000 people received advice or prescriptions in Camden. This is from all agencies—general practitioners, various advice services and voluntary bodies. In 1971 the figure was 13,400 for direct council supply and 3,000 by organisations like the Family Planning Association and Marie Stopes. In 1972, the first full free year, Camden's own figures had risen to 16,200 and the number of residents served by voluntary bodies had


risen to 5,000 bringing in the Brook Advisory Centre.
That correlation between expenditure and numbers of residents served is evidence that the House should not lightly disregard.
The hon. Member for Roxburgh, Selkirk and Peebles (Mr. David Steel) quoted the National Opinion Poll figures. I heard murmurs to the effect, "It depends on what the question was." I agree that with any public opinion poll it depends on exactly what the question is and how it is put. Perhaps the breakdown of the figures is important because, irrespective of what the question was, the answer came through clearly.
The hon. Gentleman said that 64 per cent. of those questioned thought that the Government should provide a free birth control service for all men and women. The survey went on to say that in the under-45 age group, which, if my demographic mathematics are correct, is now beginning to be somewhat larger than that of the elderly citizens, the view was held by 79 per cent. of the electorate. I shall be completely impartial. They then analysed the answers from the adherents to the three major political parties. The results showed that 62 per cent. of Conservatives supported it, 70 per cent. of Labour and 62 per cent. of Liberal voters. Those people favoured a free contraception service.
One of the reasons I am particularly interested in the subject is that one of the purposes of the Bill is, through the reorganisation, to tidy things up. London has been "tidied up". It had its reorganisation in 1964 and it is working pretty well. Camden can claim to be a forerunner in the provision of family planning services. One of the three units of the Camden-operated scheme originates from 1939 under powers taken under the Public Health (London) Act 1936. When Camden came into being in 1965 reactionary Tory Hampstead and Holborn happily accepted the view taken by St. Pancras and everyone went along with the idea. Decisions taken by Camden on two occasions have been bi-partisan with no opposing vote recorded. My hon. Friend the Minister for Housing and Construction has certain views about Camden, and so have but on this issue Camden was completely united.
It should be taken into account that in terms of rateable value on the old valuation lists Camden is the fourth wealthiest local authority in Britain. It is a major authority and it cannot be lightly dismissed. I appreciate and anticipate one argument that my right hon. Friend will put up against our amendment. He will say that what I have explained about Camden may be true but that it will cease to exist as Camden when the new areas for local authorities come in, and that it will be merged with Islington. He will say that we cannot expect only people in Camden to be able to get free service while the people in Islington are left out of the scheme. My right hon. Friend the Secretary of State has held office as Minister of Housing and Local Government. May I remind him that one of the first things we learn in local government is that when amalgamation or reorganisation comes along there is for the staff what is known as a "no detriment" or "no worsening" provision? I am not prepared as one of the Members of Parliament for Camden to see 20,000 of the electors of that borough being forced to pay for a service which has been free for two years—and it will be three years by the time the Bill becomes law.
I urge my right hon. Friend to be realistic about this and to accept that he will have what can only be called a unique opportunity to prove or disprove his ideas on the matter. If he allows these 30 or so authorities who were farsighted enough to provide a free service to continue he has the ideal basis of a controlled experiment which will show whether there is a proper uptake in Class V as mentioned, whether there is a proper co-relationship between expenditure and the number of people making use of the service. He will have the opportunity. If he can tell the House after five years "Here are the figures for the areas where we have permitted a free service to continue, and there are the figures for areas that have had no service other than the prescription charge service, and they show that a prescription charge is no deterrent", I shall be man enough to say "I was wrong". He has the chance of proving that to us without any difficulty.
I ask the House to realise that those of us advocating the course of action proposed are not calling for any extension of


the service. We are saying "Retain the service which is free, which has been provided by 30-odd local authorities".
If my right hon. Friend is not able to concede the democratic right of those authorities that freely accepted that service, after their members on both sides had fought elections, I shall have to go into the Division Lobby against him, at least on that amendment.

Sir G. Sinclair: I support Amendment No. 128. The House has heard with growing conviction the case in support of it made by my hon. Friends the Members for Norwich, South (Dr. Stuttaford) and Hampstead (Mr. Geoffrey Finsberg).
Many of us on this side who signed Early Day Motion No. 177 welcome the great advance made by my right hon. Friend the Secretary of State in the provision of family planning services, a great advance on anything this country has hitherto contemplated.
Many of us believe that the Bill goes far towards meeting the real need and the public demand. But some of us believe that it is wrong to take away from about 10 million people living in 33 local health authority areas the free services that they have enjoyed for some years—for two years in some areas and for as long as seven years in others—by provision from the rates as well as by grants from the central Government.
It is all very well for my logical and youthful hon. Friend the Member for Lewisham, West (Mr. Selwyn Gummer) to scout the evidence. It has been available to him. To say that nothing is proved is to fly in the face of what my hon. Friend the Member for Hampstead has just said and of the evidence provided by the Birth Control Campaign to my right hon. Friend in the past 10 days.

Mr. Selwyn Gummer: The facts and figures put forward by my hon. Friend the Member for Hampstead (Mr. Geoffrey Finsberg) show precisely the opposite. There was a bigger percentage rise in the number of women at the clinics between 1970 and 1971 than between 1971 and 1972. All that happened between 1971 and 1972——

Mr. Deputy Speaker: Order. Will the hon. Gentleman be so good as to address the Chair?

Mr. Selwyn Gummer: I apologise, Mr. Deputy Speaker.
The figures mean exactly the opposite to what is suggested, because the percentage rise between 1971 and 1972 was higher than that between 1971 and 1972, when the service was made free.

Sir G. Sinclair: However my hon. Friend may try to present these figures, the common sense of the local authorities and the demand that they are meeting show where public judgment lies in this sensitive matter.
If it is argued that there is insufficient evidence, it seems to me crazy to wipe out the very basis of those areas in which real evidence about the value of a free service can be gathered. This point was eloquently made by my hon. Friend the Member for Hampstead. I believe that the whole House was carried by this point. Our plea to my right hon. Friend is "Do not wipe out the control areas if a civilised and forward looking judgment is to be made on the merits of this case".

12 midnight.

Mr. David Mudd: rose——

Hon. Members: Vote.

Mr. Mudd: I support Amendment No. 7, which makes what I believe is a basically justified attack on this passport to promiscuity and easy ride into irresponsibility.

Mrs. Renée Short: You hypocrite.

Mr. Mudd: It is all very well to talk in terms of demographic surveys and social classes, but we are talking about human reaction, and human reaction is immediate reaction inspiring illegitimacy and the other problems. If people are in the discotheque on Saturday night and in bed on Sunday morning, they are not saying to each other "Let's wait for 48 hours until we have been to the clinic."
For years the Royal Navy and the Merchant Navy have enjoyed a free contraceptive service. I hope that my right hon. Friend will be able to reassure me that venereal disease and paternity orders against sailors have declined in number as a result of the availability to them of a family planning service.

Sir K. Joseph: The House is asked to deal with a group of three amendments which have been moved in very sincere speeches and supported or commented upon by equally sincere speeches. Amendment No. 7 wants us to have less family planning, as far as it comes from the State. Amendments No. 127 and 128 want more family planning to be paid for by the State. My position is clear. I ask the House to reject all three, sincere and, indeed, passionate as support for them has been. I want to put forward what I believe are very strong arguments against them.
I say in passing, because I recognise that it is of the essence of what the House wishes to discuss, that if Amendment No. 7 were passed there would be no family planning service. The Bill abolishes the power of the local authorities to provide a service and Amendment No. 7 would remove any power in the National Health Service to provide family planning advice or supplies except for those who need them for medical reasons.
I say to hon. Members—and I am guilty of this myself—that when dealing with this subject most of us tend to over-dramatise and over-simplify. It is a very difficult question. But what we are doing tonight will not lead to extreme results either way. Loose and casual people are not made loose and casual by the availability of contraceptive supplies, whether free or for 20p. By hypothesis, they do not take the trouble to equip themselves. Nor will a free service eliminate illegitimacy, unwanted pregnancies or abortions.
The reason why most of us on both sides of the House want to make a sensible increase in the availability of family planning advice and supplies is that we believe it will help reduce illegitimate and unwanted pregnancies. My hon. Friend the Member for Oldbury and Halesowen (Mr. Stokes), supported by my hon. and learned Friend the Member for Buckinghamshire, South (Mr. Ronald Bell), laid great emphasis on the first word in the phrase "family planning". He asked that any contraceptive device and all supplies provided by the taxpayer should be limited to married couples.
I can assure the House that the vast majority of users of the family planning service will be married or at least living

in stable unions. I must point out to my hon. Friend that a very large proportion of those who have illegitimate children, of those who have abortions, of those who have unwanted pregnancies, are single people. That is, I believe, why the Church leaders, recognising these facts and maintaining steadfastly their view on the prime importance of chastity before marriage and fidelity in marriage, have still recommended that the State should extend family planning advice and supplies. That is why my hon. Friend the Member for Lewisham, West (Mr. Selwyn Gummer) was quite correct in what he said.
I must turn from the larger argument to a small but important argument put forward by my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight). She asked me in Committee a totally unanswerable conundrum about the inter-relationship of the Sexual Offences Act 1956, and Clause 4 of the Bill. The point was that a doctor giving advice, as he is allowed to do under Clause 4, to a girl under the age of 16 might be thought to be conniving at an offence under the Sexual Offences Act. I told my hon. Friend and the Committee that I could not answer that question myself and that I would seek the advice of the Law Officers. I have that advice and it is that there is no conflict between Clause 4 and Sections 6 and 28 of the Sexual Offences Act.
I will if the House wishes, read it out. I can only read it out because it is legal advice. If the House will allow me, I will send it to my hon. Friend and if she wishes she can table a Parliamentary Question about it, or have it published in some other way.
I turn to Amendment No. 127, tabled by the hon. Member for Willesden, West (Mr. Pavitt), which goes in the other direction. He accepts that the Government have gone 90 per cent. of the way, in money terms, to a totally free service. He dismissed, and the House tended to dismiss, I thought unfairly, the comments of my hon. Friend the Member for Edgbaston, that £3 million is a lot of money and there are many other priorities. A number of my hon. Friends from time to time worry about the level of public expenditure.
I am not this evening leaning heavily on the argument of other priorities for the


£3 million. The reason why the Government so firmly believe that it is right to make a prescription charge for contraceptive supplies, except for the relevant exempt categories, is that we believe it is right to normalise the family planning service, to make it a normal ingredient of medical consultation and, to that extent, equipment.
The prescription charge is normal and taken for granted. There are exemptions. The exemptions relevant for our purposes are those for a mother for a year after childbirth, and for people who are receiving supplementary benefit or family income supplement. They get automatic exemption, while those who are just above supplementary benefit level may make application for it. There is no evidence that has been given to the House or country that a 20p charge will deter people who would take the trouble to seek prescriptions if the supply were free.
I shall draw the threads together before I finish, if I can, but I turn now to Amendment No. 128 proposed by my hon. Friend the Member for Norwich, South (Dr. Stuttaford) and strongly supported by my hon. Friend the Member for Hampstead (Mr. Geoffrey Finsberg) and my hon. Friend the Member for Dorking (Sir G. Sinclair). This amendment would preserve the free service in the new health geographical areas, in such areas as contain at the moment a local authority area in which a free service is being provided. I could make a number of administrative arguments against this, but, again, I will not lean on them. I wish to take the argument head on.
I maintain that there is absolutely no reason in family planning policy to maintain what I might call for convenience the present free zones. It is true that in the present free zones there is increased use of the service, but as my hon. Friend the Member for Lewisham, West rightly points out, what would one expect if there is greatly increased advertising, what would one expect if doctors, nurses, administrators take infinite trouble to adapt opening hours of clinics for access by the public and to make it as easy as possible to get advice and supplies?
Above all—I ask the House to heed the argument—it is very natural that people should go to use free supplies when the alternative is supplies at com

mercial prices. This is the alternative at the moment. In the areas where a local authority offers a free service the alternatives are stark: they are, first, a free service if one goes to the clinics—and many of the people who use clinics do not come from that local authority area—and, second, there is the commercial charge, varying at the moment, let us say, between £4 and £6 a year. Well, of course, the contrast is so sharp one would expect an increased take up when the service is free. There is absolutely no evidence that any substantial part of the increased take up is accounted for by people who have not hitherto at all been using contraceptives.
The position after April next year will be another contrast altogether. There will not be a contrast between free and £4 or £6 a year. The contrast will be a loss of a free service and a charge of 20p for a prescription. Therefore, I say to my hon. Friends that, despite the argument from Camden, the case has not been proven.
When the hon. Member for Roxburgh, Selkirk and Peebles (Mr. David Steel) says the Government are flying in the face of the evidence I say it is he who is ignoring the fact that there is no evidence that a free service has reached effectively into those groups in the population who never have used contraceptives at all.
My hon. Friend the Member for Norwich, South was particularly worried because there might not be availability for male demand of sheaths if we were to abolish the free clinics. I must tell my hon. Friend that in the free clinics which particularly seek to make available sheaths to men there has been extremely little demand by men on their own account. That may sound very odd, but I mean that there are cases where women, who with their husbands prefer sheaths on preferred contraceptive advice, have gone to the clinics and asked for sheaths. That will continue, where this has been so, in the future. But there has been very little take up by men.
I must make reference to Aberdeen because the hon. Member for Aberdeen, North (Mr. Robert Hughes), with great sincerity, spoke on the subject. It is hard, as he recognises, to disentangle the effect on abortion of contraception. I have great respect for Aberdeen's efforts for the public good, but I must point out


that, taking the legitimate birth rate alone, over 10 years from 1962, despite Aberdeen's free service, the birth rate fell by 14 per cent., compared with much larger falls in the three cities of Dundee, Edinburgh and Glasgow, three cities which were not offering a free service.
These figures can be interpreted as meaning that Aberdeen has made considerable achievements with its family planning services, but they do nothing to support the thesis that the greater generosity with which family planning supplies have been given in Aberdeen has resulted in a fall of births whereas in cities which have not given free supplies there has not been a fall in births.
12.15 a.m.
I come now to the most formidable argument of all—if I may make such an invidious remark. The hon. Member for Ponytpool (Mr. Abse) made a powerful speech in which he fought me with my own weapons. He rightly pointed out that the Government are dedicated to an attempt, however difficult, to reduce the cycle of deprivation and the creation of problem families. We all know that that is a difficult problem, and we are suitably diffident in approaching it.
The hon. Gentleman asks how, in the face of this self-imposed task, we can remove the possibility of totally free supplies to those, admittedly often casual, households. I say to the hon. Gentleman, whose views on this subject I very much respect, that the people whom he is discussing and in whom I am particularly interested will not be helped by the opening of clinics. They will not be helped by the sort of service we all have in mind. They need domiciliary advice. Skilled doctors and nurses with the gift of persuasion are needed to persuade married couples that for their own benefit they need to use contraceptive techniques.
When the hon. Gentleman says that it is necessary to use the technique of overkill—to be wasteful with that last £3 million—to reach the most casual in society, he deludes himself. Even totally free services will not reach the most casual. We need to reach out to them through the local authorities with domiciliary advice, and that is what the Government have consistently said during the three years

we have been in office and what will be the centre of our plans from April 1974.
I conclude by reminding the House of the Government's strategy, which is to normalise family planning advice and supplies within the National Health Service. Hon. Members are apt to generalise about public opinion. It is true that many members of the public believe that it would be right to have a totally free service. On the other hand, many people believe that that would be to go too far and that it is fair enough to treat contraceptive supplies as we treat life-saving medicines and charge 20p for them.
There is no argument that those who are casual will be deterred by the 20p charge. The casual will not be reached either by a free service or by a 20p service. Therefore, I say to the House and particularly to my hon. Friends, let the Government put the family planning service within the National Health Service and normalise it. That is why I ask my hon. Friends to reject—however sincerely they were moved—Amendments Nos. 7, 127 and 128.

Dr. Summerskill: The Opposition are to have a free vote, and I regret that hon. Members on the Government benches are not to be allowed the same facility. I trust that the 70 hon. Members who signed the motion asking for a totally free family planning service will be consistent and go into the Lobby to support Amendment No. 127.
The Secretary of State has been at his most passionate tonight defending a case which until the Lords amended the Bill he did not extol so passionately. But we are now in the position of having before us a Bill from which the Lords Amendment was removed in Committee in another place by a majority of 12 votes to 11. The Government now wish to retain the Bill as it was before it went to the Lords.
We have heard speeches from both sides of the House advocating the case for a totally free service. When the right hon. Gentleman the Secretary of State for Social Services claims that he is trying to normalise the family planning service he is indulging in a great deal of wishful thinking. He is, for example, labouring under the belief that a charge has been imposed which has been reduced to such


a level that nobody could possibly be defeated by it. This is purely a matter of opinion. There is a great body of opinion that the charge is a deterrent, and that opinion includes the British Medical Association and the 33 local authorities which are now running a free family planning service.
The Secretary of State believes that the exemptions will be helpful, but the exemptions include a majority of people under the age of 15 or over the age of 65. The charges are based on the charges for drugs used in the treatment of sickness. Preventive medicine is free in this country; curative medicine has a charge attached to it. Therefore it is totally illogical to base the charge on curative medicine and not on preventive medicine. At the same time, despite protests from all the 33 local authorities—including the West Riding, in which the Secretary of State's own constituency is situated—a measure is being brought in which will reverse a free system and is reactionary and regressive. This dilemma has been created in the last few weeks because of the Lords Amendment which reversed the Government's policy.
When one examines the policy put forward by the Government, with its anomalies, injustices and discrepancies in so many ways, it is clear that the only

fair, just and humanitarian system of family planning is to have a totally free service easily available to everybody. This would be sound on economic, social and medical grounds. It has the support of the British Medical Association and of every progressive local authority.

If Amendment No. 127, which stands in the name of my hon. Friend the Member for Willesden West (Mr. Pavitt), is not agreed to, I suggest that the second best is Amendment No. 128, which stands in the name of the hon. Member for Norwich, South (Dr. Stuttaford) since at least it would prevent a regressive state of affairs and would be better than nothing. But the only fair and just way is to support the amendment for a totally free service.

Amendment negatived.

Amendment proposed: No. 127, in page 4, line 7, leave out from 'and' to end of Clause and insert
'such arrangements shall provide that no charge shall be made for any such medical examination or treatment or for the supply of any such substances or appliances'.—[Mr.Pavitt.]

Question put, That the Amendment be made:—

The House divided: Ayes 127, Noes 243.

Division No. 151.]
AYES
[12.25 a.m.


Abse, Leo
Dell, Rt. Hn. Edmund
Jeger, Mrs. Lena


Allaun, Frank (Salford, E.)
Douglas-Mann, Bruce
Jenkins, Hugh (Putney)


Armstrong, Ernest
Driberg, Tom
Jenkins, Rt. Hn. Roy (Stechford)


Atkinson, Norman
Edwards, Robert (Bilston)
John, Brynmor


Barnes, Michael
Edwards, William (Merioneth)
Johnston, Russell (Inverness)


Bidwell, Sydney
Ellis, Tom
Jones, T. Alec (Rhondda, W.)


Blenkinsop, Arthur
English, Michael
Kinnock, Neil


Booth, Albert
Fernyhough, Rt. Hn. E.
Lambie, David


Boothroyd, Miss B. (West Brom.)
Fisher, Mrs. Doris (B' ham, Lady wood )
Lamborn, Harry


Brown, Hugh D. (G'gow, Proven)
Fletcher, Ted (Darlington)
Lamond, James


Buchan, Norman
Foot, Michael
Leonard, Dick


Butler, Mrs. Joyce (Wood Green)
Ford, Ben
Lewis, Arthur (W. Ham, N.)


Carmichael, Neil
Forrester, John
Lyon, Alexander W. (York)


Carter-Jones, Lewis (Eccles)
Fraser, John (Norwood)
McCartney, Hugh


Castle, Rt. Hn. Barbara
Galpern, Sir Myer
McGuire, Michael


Clark, David (Colne Valley)
Garrett, W. E.
Machin, George


Cocks, Michael (Bristol, S.)
Gibert, Dr. John
Mackie, John


Coleman, Donald
Grant, John D. (Islington, E.)
Mackintosh, John P.


Concannon, J. D.
Griffiths, Eddie (Brightside)
McMillan, Tom (Glasgow, C.)


Crawshaw, Richard
Hamilton, William (Fife, W.)
McNamara, J. Kevin


Cronin, John
Hannan, William (G'gow, Msryhill)
Mallalieu, J. P. W. (Huddersfield, E.)


Crosland, Rt. Hn. Anthony
Hardy, Peter
Marquand, David


Cunningham Dr. J. A. (Whitehaven)
Hart, Rt. Hn. Judith
Maxwell-Hyslop, R. J.


Dalyell, Tam
Horam, John
Mayhew, Christopher


Davies, G. Elfed (Rhondda, E.)
Houghton, Rt. Hn. Douglas
Mendelson, John


Davies, Ifor (Gower)
Howell, Denis (Small Heath)
Mikardo, Ian


Davis, Clinton (Hackney, C.)
Hughes, Robert (Aberdeen, N.)
Miller, Dr. M. S.


Davis, Terry (Bromsgrove)
Hughes, Roy (Newport)
Mitchell, R. C. (S'hampton, Itchen)


Deakins, Eric
Iremonger, T. L.
Molloy, William


de Freltas, Rt. Hn. Sir Geoffrey
Janner, Graville
Orme, Stanley




Oswaid, Thomas




Owen, Dr. David (Plymouth, Sutton)
Silkin, Rt. Hn. John (Deptford)
Tinn, James


Palmer, Arthur
Silkin, Hn. S. C. (Dulwich)
Tope, Graham


Parker, John (Dagenham)
Silverman, Julius
Urwin, T. W.


Radice, Giles
Smith, Cyril (Rochdale)
Walden, Brian (B'm'ham, All Saints)


Reed, D. (Sedgefield)
Smith, John (Lanarkshire, N.)
Watkins, David


Reed, Laurance (Bolton, E.)
Spearing, Nigel
Whitehead, Phillip


Roderick, Caerwyn E.(Brc'n&amp;R'dnor)
Stallard, A. W.
Williams, W. T. (Warrington)


Rodgers, William (Stockton-on-Tees)
Stewart, Rt. Hn. Michael (Fulham)
Woof, Robert


Roper, John
Stoddart, David (Swindon)



Rowlands, Ted
Strauss, Rt. Hn. G. R.
TELLERS FOR THE AYES:


Sandelson, Neville
Stuttaford, Dr. Tom
Mr. Laurie Pavitt and Mr. David Steel.


Shore, Rt. Hn. Peter (Stepney)
Summerskill, Hn. Dr. Shirley



Short, Mrs. Renée (W'hampton.N.E.)
Thomas, Rt. Hn.George (Cardiff, W.)





NOES


Adley, Robert
Fidler, Michael
Lloyd, Ian (P'tsm'th, Langstone)


Alison, Michael (Barkston Ash)
Fisher, Nigel (Surbiton)
Loveridge, John


Allason, James (Hemel Hempstead)
Fletcher-Cooke, Charles
MacArthur, Ian


Archer, Jeffrey (Louth)
Fookes, Miss Janet
McCrindle, R. A.


Astor, John
Fortescue, Tim
McLaren, Martin


Atkins, Humphrey
Foster, Sir John
Maclean, Sir Fitzroy


Awdry, Daniel
Fowler, Norman
McMaster, Stanley


Baker, Kenneth (St. Marylebone)
Fox, Marcus
McNair-Wilson, Michael


Baker, W. H. K. (Banff)
Fraser,Rt.Hn.Hugh(St'fford &amp; Stone)
McNair-Wilson, Patrick (New Forest)


Balniel, Rt. Hn. Lord
Galbraith, Hn. T. G. D.
Maddan, Martin


Batsford, Brian
Gardner, Edward
Madel, David


Bell, Ronald
Gibson-Watt, David
Mahon, Simon (Bootle)


Bennett, Sir Frederic (Torquay)
Gilmour, Ian (Norfolk, C.)
Marten, Neil


Bennett, Dr. Reginald (Gosport)
Glyn, Dr. Alan
Mather, Carol




Maude, Angus


Benyon, W.
Godber, Rt. Hn. J. B.
Mawby, Ray


Berry, Hn. Anthony
Gorst, John
Meyer, Sir Anthony


Bitten, John
Gower, Raymond
Mills, Peter (Torrington)


Biggs-Davison, John
Grant, Anthony (Harrow, C.)
Miscampbell, Norman


Boardman, Tom (Leicester, S.W.)
Gray, Hamish
Mitchell, David (Basingstoke)


Boscawen, Hn. Robert
Green, Alan
Moate, Roger


Braine, Sir Bernard
Grieve, Percy
Money, Ernle


Bray, Ronald
Griffiths, Eldon (Bury St. Edmunds)
Monks, Mrs. Connie


Brown, Sir Edward (Bath)
Grylls, Michael
Monro, Hector


Bruce-Gardyne, J.
Gummer, J. Selwyn
More, Jasper


Bryan, Sir Paul
Gurden, Harold
Morgan-Giles, Rear-Adm.


Buchanan-Smith, Alick(Angus, N&amp;M)
Hall, Miss Joan (Keighley)
Mudd, David


Buck, Antony
Hall, John (Wycombe)
Neave, Airey


Bullus, Sir Eric
Hall-Davis, A. G. F.
Noble, Rt. Hn. Michael


Burden, F. A.
Hamilton, James (Bothwell)
Normanton, Tom


Butler, Adam (Bosworth)
Hamilton, Michael (Salisbury)
Nott, John


Campbell, Rt.Hn.G. (Moray &amp; Nairn)
Harrison, Col. Sir Harwood (Eye)
O'Halloran, Michael


Carlisle, Mark
Haselhurst, Alan
Onslow, Cranley


Carr, Rt. Hn. Robert
Hastings, Stephen
Oppenheim, Mrs. Sally


Channon, Paul
Havers, Sir Michael
Page, Rt. Hn. Graham (Crosby)


Chapman, Sydney
Heseltine, Michael
Parkinson, Cecil(Harrow, W.)




Parkinson, Ceil


Chataway, Rt. Hn. Christopher
Higgins, Terence L.
Percival, Ian


Chichester-Clark, R.
Hiley, Joseph
Pike, Miss Mervyn


Clarke, Kenneth (Rushcliffe)
Hill, John E. B. (Norfolk, S.)
Pink, R. Bonner


Clegg, Walter
Hill, S. James A. (Southampton, Test)
Pounder, Rafton


Cockeram, Eric
Holland, Philip
Powell, Rt. Hn. J. Enoch


Cohen, Stanley
Holt, Miss Mary
Price, David (Eastleigh)


Cooper, A. E.
Hordern, Peter
Prior, Rt. Hn. J. M. L.


Cordle, John
Hornsby-Smith.Rt.Hn.Dame Patricia
Proudfoot, Wilfred


Corfield, Rt. Hn. Sir Frederick
Howe, Rt. Hn. Sir Geoffrey
Raison, Timothy


Cormack, Patrick
Howell, David (Guildford)
Rawlinson, Rt. Hn. Sir Peter


Costain, A. P.
Howell, Raiph (Norfolk, N.)
Redmond, Robert


Critchley, Julian
Hutchison, Michael Clark
Rees, Peter (Dover)


Crouch, David
Irvine, Bryant Godman (Rye)
Rhys Williams, Sir Brandon


Crowder, F. P.
James, David
Ridley, Hn. Nicholas


Dalkeith, Earl of
Jenkin, Patrick (Woodford)
Rippon, Rt. Hn. Geoffrey


d'Avigdor-Goldsmid, Sir Henry
Johnson Smith, G. (E. Grinstead)
Roberts, Wyn (Conway)


d'Avigdor-Goldsmid.Maj. -Gen. Jack
Jones, Arthur (Northants, S.)
Rossi, Hugh (Hornsey)


Dean, Paul
Jopling, Michael
Rost, Peter


Dixon, Piers
Joseph, Rt. Hn. Sir Keith
Russell, Sir Ronald


Dodds-Parker, Sir Douglas
Kaberry, Sir Donald
St. John-Stevas, Norman


Drayson, G. B.
Kellett-Bowman, Mrs. Elaine
Scott, Nicholas


du Cann, Rt. Hn. Edward
Kimball, Marcus
Scott-Hopkins, James


Dykes, Hugh
King, Evelyn (Dorset, S.)
Shaw, Michael (Sc'b'gh &amp; Whitby)


Eden, Rt. Hn. Sir John
Kirk, Peter
Shelton, William (Clapham)


Edwards, Nicholas (Pembroke)
Kitson, Timothy
Shersby, Michael


Elliot, Capt. Walter (Carshalton)
Knight, Mrs. Jill
Simeons, Charles


Elliott, R. W. (N'c'tle-upon-Tyne.N.)
Knox, David
Skeet, T. H. H.


Emery, Peter
Lamont, Norman
Smith, Dudley (W'wick &amp; L'mington)


Eyre, Reginald
Lane, David
Soref, Harold


Farr, John
Langford-Holt, Sir John
Speed, Keith


Fenner, Mrs. penal
Le Merchant, Spencer
Spence, John




Sproat, Iain
Tilney, John
Weatherill, Bernard


Stainton, Keith
Trafford, Dr. Anthony
Wells, John (Maidstone)


Stanbrook, Ivor
Trew, Peter
Wiggin, Jerry


Stewart-Smith, Geoffrey (Belper)
Tugendhat, Christopher
Wilkinson, John


Stodart, Anthony (Edinburgh, W.)
Turton, Rt. Hn. Sir Robin
Winterton, Nicholas


Stokes, John
Van Straubenzee, W. R.
Wolrige-Gordon, Patrick


Sutcliffe, John
Vaughan, Dr. Gerard
Wood, Rt. Hn. Richard


Tapsell, Peter
Vickers, Dame Joan
Woodnutt, Mark


Taylor, Sir Charles (Eastbourne)
Waddington, David
Worsley, Marcus


Taylor, Frank (Moss Side)
Walder, David (Clitheroe)
Wylie, Rt. Hn. N. R.


Taylor, Robert (Croydon, N.W.)
Walker, Rt. Hn. Peter (Worcester)
Younger, Hn. George


Tebbit, Norman
Walker-Smith, Rt. Hn. Sir Derek



Temple, John M.
Wall, Patrick
TELLERS FOR THE NOES:


Thomas, John Stradling (Monmouth)
Walters, Dennis
Mr. Paul B. Hawkins and Mr. Oscar Murton.


Thomas, Rt. Hn. Peter (Hendon, S.)
Ward. Dame Irene



Thompson, Sir Richard (Croydon, S.)
Warren, Kenneth

Question accordingly negatived.

Amendment proposed: No. 128, in page 4, line 11, at end insert:
'save that the Secretary of State shall ensure that no such prescription charges are made by any Area Health Authorities where a local health authority was at the time of passing

of this Act already providing a family plan ping service free of charge for all advice and supplies '.—[Dr. Stuttaford.]

Question put, That the amendment be made:—

The House divided: Ayes 138, Noes 240.

Division No. 152.]
AYES
[12.35 a.m.


Abse, Leo
Garrett, W. E.
Orme, Stanley


Allaun, Frank (Salford E.)
Gilbert, Dr. John
Oswald, Thomas


Armstrong, Ernest
Grant, John D. (Islington, E.)
Owen, Dr. David (Plymouth, Sutton)


Atkinson, Norman
Griffiths, Eddie (Brightside)
Palmer, Arthur


Barnes, Michael
Hamling, William
Parker, John (Dagenham)


Bidwell, Sydney
Hannan, William (G'gow, Maryhill)
Pavitt, Laurie


Blenkinsop, Arthur
Hardy, Peter
Quennell, Miss J. M.


Booth, Albert
Hart, Rt. Hn. Judith
Radice, Giles


Boothroyd, Miss B. (West Brom.)
Hicks, Robert
Reed, D. (Sedgefield)


Bowden, Andrew
Horam, John
Reed, Laurance (Bolton, E.)


Brown, Hugh D. (G'gow, Provan)
Hornby, Richard
Renton, Rt. Hn. Sir David


Buchan, Norman
Houghton, Rt. Hn. Douglas
Roderick,Caerwyn E.(Br'c'n&amp;R'dnor)


Butler, Mrs. Joyce (Wood Green)
Howell, Denis (Small Heath)
Rodgers, William (Stockton-on-Tees)


Carmichael, Neil
Hughes, Robert (Aberdeen, N.)
Roper, John


Carter-Jones, Lewis (Eccles)
Hughes, Roy (Newport)
Rowlands, Ted


Castle, Rt. Hn. Barbara
Hunt, John
Sandelson, Neville


Clark, David (Colne Valley)
Iremonger, T. L.
Shore, Rt. Hn. Peter (Stepney)


Cocks, Michael (Bristol, S.)
Janner, Greville
Short, Mrs. Renée (W'hampton, N.E.)


Coleman, Donald
Jeger, Mrs. Lena
Silkin, Rt. Hn. John (Deptford)


Concannon, J. D.
Jenkins, Hugh (Putney)



Crawshaw, Richard
Jenkins, Rt. Hn. Roy (Stechford)
Silkin, Hn. S. C. (Dulwich)


Cronin, John
Jessel, Toby
Silverman, Jullus


Crosland, Rt. Hn. Anthony
John, Brynmor
Sinclair, Sir George


Crossman, Rt. Hn. Richard
Johnston, Russell (Inverness)
Smith, Cyril (Rochdale)


Cunningham, Dr. J. A. (Whitehaven)
Jones, T. Alec (Rhondda, W.)
Smith, John (Lanarkshire, N )


Dalyell, Tam
Kinnock, Neil
Spearing, Nigel


Davies, G. Elfed (Rhondda, E.)
Lambie, David
Stainton, Keith


Davies, Ifor (Gower)
Lamborn, Harry
Stallard, A. W.


Davis, Clinton (Hackney, C.)
Lamond, James
Steel, David


Davis, Terry (Bromsgrove)
Leonard, Dick
Stewart, Rt. Hn. Michael (Fulham)


Deakins, Eric
Lewis, Arthur (W. Ham, N.)
Stoddart, David (Swindon)


de Freitas, Rt. Hn. Sir Geoffrey
Lomas, Kenneth
Strauss, Rt. Hn. G. R.


Dell, Rt. Hn. Edmund
Lyon, Alexander W. (York)
Stuttaford, Dr. Tom


Digby, Simon Wingfield
McGuire, Michael
Summerskill, Hn. Dr. Shirley


Douglas-Mann, Bruce
Machin, George
Thomas,Rt.Hn.Georgo (Cardiff,W.)


Driberg, Tom
Mackie, John
Tinn, James


Edwards, Robert (Bilston)
Mackintosh, John P.
Tope, Graham


Edwards, William (Merioneth)
McMillan, Tom (Glasgow, C.)
Urwin, T. W.


Ellis, Tom
McNamara, J. Kevin
Vickers, Dame Joan


English, Michael
Mallalieu, J. P. W. (Huddersfield, E.)
Walden, Brian (B'm'ham, All Saints)


Fernyhough, Rt. Hn. E.
Marquand, David
Watkins, David


Finsberg, Geoffrey (Hampstead)
Mayhew, Christopher
Whitehead, Phillip


Fisher, Mrs. Doris (B' ham, Ladywood)
Mendelson, John
Williams, W. T. (Warrington)


Fletcher, Ted (Darlington)
Mikardo, Ian
Woof, Robert


Foot, Michael
Miller, Dr. M. S.
TELLERS FOR THE AYES:


Forrester, John
Mitchell, R. C. (S'hampton, Itchen)
Mr. R. Maxwell-Hyslop and Mr. N. Winterton


Fraser, John (Norwood)
Molloy, William



Galpern, Sir Myer






NOES


Adley, Robert
Amery, Rt. Hn. Julian
Atkins, Humphrey


Allson, Michael (Barkston Ash)
Archer, Jeffrey (Louth)
Awdry, Daniel


Allason, James (Hemel Hempstead)
Astor, John
Baker, Kenneth (St. Marylebone)




Baker, W. H. K. (Banff)
Griffiths, Eldon (Bury St. Edmunds)
Page, John (Harrow, W.)


Balniel, Rt. Hn. Lord
Grylls, Michael
Parkinson, Cecil


Batsford, Brian
Gummer, J. Selwyn
Percival, Ian


Bell, Ronald
Gurden, Harold
Pike, Mist Mervyn


Bennett, Sir Frederic (Torquay)
Hall, Miss Joan (Keighley)
Pink, R. Bonner


Bennett, Dr. Reginald (Gosport)
Hall, John (Wycombe)
Pounder, Rafton


Benyon, W.
Hall-Davis, A. G. F.
Powell, Rt. Hn. J. Enoch


Berry, Hn. Anthony
Hamilton, James (Bothwell)
Price, David (Eastleigh)


Biffen, John
Hamilton, Michael (Salisbury)
Prior, Rt. Hn. J. M. L.


Biggs-Davison, John
Harrison, Col. Sir Harwood (Eye)
Proudfoot, Wilfred


Boardman, Tom (Leicester, S.W.)
Haselhurst, Alan
Raison, Timothy


Boseawen, Hn. Robert
Hastings, Stephen
Rawlinson, Rt. Hn. Sir Peter


Braine, Sir Bernard
Havers, Sir Michael
Redmond, Robert


Bray, Ronald
Hawkins, Paul
Rees, Peter (Dover)


Brown, Sir Edward (Bath)
Heseltine, Michael
Rhys Williams, Sir Brandon


Bruce-Gardyne, J.
Higgins, Terence L.
Ridley, Hn. Nicholas


Bryan, Sir Paul
Hiley, Joseph
Rippon, Rt. Hn. Geoffrey


Buchanan-Smith, Alick(Angus,N&amp;M)
Hill, John E. B. (Norfolk, S.)
Roberts, Wyn (Conway)


Buck, Antony
Hill, James (Southampton, Test)
Rossi, Hugh (Hornsey)


Bullus, Sir Eric
Holland, Philip
Rost, Peter


Burden, F. A.
Holt, Miss Mary
Russell, Sir Ronald


Butler, Adam (Bosworth)
Hordern, Peter
St. John-Stevas, Norman


Campbell, Rt.Hn.G.(Moray &amp; Nairn)
Hornsby-Smith.Rt.Hn.Dame Patricla
Scott, Nicholas


Carlisle, Mark
Howe, Rt. Hn. Sir Geoffrey
Scott-Hopkins, James


Carr, Rt. Hn. Robert
Howell, David (Guildford)
Shaw, Michael (Sc'b'gh &amp; Whitby)


Channon, Paul
Howell, Ralph (Norfolk, N.)
Shelton, William (Clapham)


Chapman, Sidney
Hutchison, Michael Clark
Shersby, Michael


Chataway, Rt. Hn. Christopher
Irvine, Bryant Godman (Rye)
Simeons, Charles


Chichester-Clark, R.
James, David
Skeet, T. H. H.


Churchill, W. S.
Jenkin, Patrick (Woodford)
Smith, Dudley (W'wick &amp; L'mington)


Clark, William (Surrey, E.)
Johnson Smith, G. (E. Grinstead)
Soref, Haroid


Clegg, Walter
Jones, Arthur (Northants, S.)
Speed, Keith


Cockeram, Eric
Jopling, Michael
Spence, John


Cohen, Stanley
Joseph, Rt. Hn. Sir Keith
Sproat, Iain


Cooper, A. E.
Kaberry, Sir Donald
Stan brook, Ivor


Cordle, John
Kellett-Bowman, Mrs. Elaine



Corfield, Rt. Hn. Sir Frederick
Kimball Marcus
Stewart-Smith, Geoffrey (Belper)


Cormack, Patrick
King, Evelyn (Dorset, S.)
Stodart, Anthony (Edinburgh, W.)


Costain, A. P.
Kirk, Peter
Stokes, John


Crouch, David
Kitson, Timothy
Sutcliffe, John


Crowder, F. P.
Knight, Mrs. Jill
Tapsell, Peter


Dalkeith, Earl of
Knox, David
Taylor, Sir Charles (Eastbourne)


d'Avigdor-Goldsmid, Sir Henry
Lamont, Norman
Taylor, Frank (Moss Side)


d'Avigdor-Goldsmld,Maj.-Gen.Jack
Lane, David
Taylor, Robert (Croydon, N.W.)


Dean, Paul
Langford-Holt, Sir John
Tebbit, Norman


Dixon, Piers
Le Marchant, Spencer
Temple, John M.


Dodds-Parker, Sir Douglas
Lloyd, Ian (P'tsm'th, Langstone)
Thomas, John Stradling (Monmouth)


Drayson, G. B.
Loveridge, John
Thomas, Rt. Hn. Peter (Hendon, S.)


du Cann, Rt. Hn. Edward
MacArthur, Ian
Thompson, Sir Richard (Croydon, S.)


Dykes, Hugh
McLaren, Martin
Tilney, John


Eden, Rt. Hn. Sir John
Maclean, Sir Fitzroy
Trafford, Dr. Anthony


Edwards, Nicholas (Pembroke)
McMaster, Stanley
Trew, Peter


Elliot, Capt. Walter (Carshalton)
McNalr-Wilson, Michael
Tugendhat, Christopher


Elliott, R. W. (N'c'tle-upon-Tyne,N.)
McNair-Wilson, Patrick (New Forest)
Turton, Rt. Hn. Sir Robin


Emery, Peter
Maddan, Martin
van Straubenzee, W. R.


Eyre, Reginald
Mahon, Simon (Bootle)
Vaughan, Dr. Gerard


Farr, John
Marten, Neil
Waddington, David


Fenner, Mrs. Peggy
Mather, Carol
Walder, David (Clitheroe)


Fidler, Michael
Maude, Angus
Walker, Rt. Hn. Peter (Worcester)


Fisher, Nigel (Surbiton)
Mawby, Ray
Walker-Smith, Rt. Hn. Sir Derek


Fletcher-Cooke, Charles
Meyer, Sir Anthony
Wall, Patrick


Fookes, Miss Janet
Mills, Peter (Torrington)
Walters, Dennis


Fortescue, Tim
Miscampbell, Norman
Ward, Dame Irene


Foster, Sir John
Mitchell, David (Basingstoke)
Warren, Kenneth


Fowler, Norman
Moate, Roger
Weatherill, Bernard


Fox, Marcus
Money, Ernie
Wells, John (Maidstone)


Fraser,Rt.Hn.Hugh(St'fford &amp; Stone)
Monks, Mrs. Connie
Wiggin, Jerry


Galbraith, Hn. T. G. D.
Monro, Hector
Wilkinson, John


Gardner, Edward
More, Jasper
Wolrige-Gordon, Patrick


Gibson-Watt, David
Morgan-Giles, Rear-Adm.
Wood,Rt. Hn. Richard


Gilmour, Ian (Norfolk, C.)
Mudd, David
Worsley, Marcus


Glyn, Dr. Alan
Neave, Airey
Wylie, Rt. Hn. N. R.


Godber, Rt. Hn. J. B.
Nobie, Rt. Hn. Michael
Younger, Hn. George


Gorst, John
Normanton, Tom



Gower, Raymond
Nott, John
TELLERS FOR THE NOES


Grant, Anthony (Harrow, C.)
O'Halloran, Michael



Gray, Hamish
Onslow, Cranley
Mr. Kenneth Clarke and Mr. Oscar Murton.


Green, Alan
Oppenheim, Mrs. Sally



Grieve, Percy
Page, Rt. Hn. Graham (Crosby)

Question accordingly negatived.

Clause 5

REGIONAL AND AREA HEALTH AUTHORI TIES, FAMILY PRACTITIONER COM MITTEES AND SPECIAL HEALTH AUTHORITIES

12.45 a.m.

Mr. Lamborn: I beg to move Amendment No. 131, in page 4, line 22, leave out 'and the said regions'.

Mr. Deputy-Speaker (Mr. E. L. Mallalieu): With this amendment we can discuss the following amendments:
No. 132, in page 4, line 25, at end insert:
'(2) The areas for Area Health Authorities in England shall be the same as the areas for which the local authorities are—

(a) in Greater London, the Council of a London Borough (except in the case of the City of London which shall be included in the Area Health Authority for such adjoining London Borough as the Secretary of State may determine);
(b) in Metropolitan Counties, the Council of the Metropolitan District Council; and
(c) elsewhere the County Council'.


No. 133, in Clause 10, page 12, line 24, column 2, leave out 'each district wholly or partly' and insert 'the district'.
No. 134, in page 12, line 31, column 2, leave out 'each London borough wholly or partly' and insert 'the London borough'.

Mr. Lamborn: In putting forward two amendments earlier today—or, rather, yesterday—having special reference to the London area, I was met with the steadfast opposition of the Under-Secretary to any suggestion that London should be treated in a manner different from the rest of the country. In this amendment I am seeking to have London treated in the same way as district councils throughout the country.
The White Paper outlining the proposals for re-examining the health service stated that
It is crucially important for the citizen requiring help of both the health and social services that collaboration between the two should be firmly established. This points to the need of identity between the health area and the local authority responsible for the personal social services.
That is true—and it is as true and as valid for the London area as for the rest of the country.
Let us consider the proposed composition of the area health authorities in the London area. We have 16 authorities for the area covering 32 London boroughs. Four area health authorities have an area corresponding with the area of the individual London borough, eight authorities cover the area of two London boroughs, and the remaining four area health authorities each have three boroughs in their areas.
The London Boroughs Association advised me—and I have no doubt that it advised the Secretary of State—that the 32 individual boroughs in the London area have strongly represented their view that their areas should correspond with the areas of the health authorities. That would meet the Secretary of State's view that the areas of the Social Services Department and the area of the health authorities should be similar. It would also mean that the boundaries of the local medical committees, which are themselves established on the basis of the borough boundaries, would coincide with the boroughs—and, of course, if the amendment were accepted, with the area health authorities.
The only reason I have heard advanced in favour of the hotchpotch arrangement that has been conceived in the Bill is the difficulty of relating the hospital catchment areas to the borough boundaries. That situation would arise whatever boundary were established for the area health authorities, because the catchment areas of the hospitals have been built up quite independently of the boroughs. They serve a different area, and will continue to do so whether we juggle about by having one borough, or by putting two boroughs together or three boroughs together.
I want to refer to my area, where the area health authority is established to serve the boroughs of Lambeth, Lewisham and Southwark, joined together to form the area of one area health authority. Of the hospitals within it, King's College draws 85 per cent. of its patients from the area of the three boroughs, Lewisham draws 74 per cent., St. Thomas's draws 61 per cent. and Guy's draws as little as 48 per cent.

Mr. F. P. Crowder (Ruislip-Northwood): Within the borough of Hillingdon, being Ruislip and Northwood, to


what extent and in what form has representation been made?

Mr. Lamborn: I have received representations from the London Boroughs Association, which advises me, as I said earlier, that each of the boroughs has pressed within the association for the boundaries of the area health boards to be coterminous with the individual boroughs.

Mr. Mayhew: I wonder whether my hon. Friend is properly informed on that point. I am sure that my borough is happy to have a single area health authority for itself and for Bexley.

Mr. Lamborn: I can only say that my hon. Friend is misinformed. I was talking to the Chairman of the London Boroughs Association only yesterday evening. It was made clear to me that all of the 32 boroughs which the association represents wish that the boundary of the area health board should be coterminous with that of the borough.
The point that I was making earlier was that however one drew the boundary of an area health board one could not get it to coincide with the boundaries of the hospital catchment areas. The individual boroughs, however, will continue to provide the supporting social services for their areas. They will be providing for services for the same people in the same areas as they are at present, so there can be no case for departing from the principle which applies outside London. Outside London the areas of the area health boards and the borough boundaries, and those of the organisations established by general practitioners for their local medical committees, work together in unison. The hospital catchment area will continue to deal with patients from an area different from that of the area health board, however that area is established.
The constant and basic factor is the borough boundary, which is known to those in the area who know that the supporting services they will require come from that area. What is true for the rest of the country—that the collaboration between the social services and the area health boards can best be established by their operating within the same boundary—is equally true in London.

Mr. Michael Shersby: Is the hon. Gentleman speaking particularly of inner London boroughs or of outer London boroughs? I have had no representations from the London borough of Hillingdon which is the local authority encompassing my constituency of Uxbridge. We have no problems of this kind.

Mr. Lamborn: I cannot be responsible for the liaison which individual hon Members have established with the local authorities in their area. I move the amendment at the behest of the London Boroughs Association which advises me that all the London boroughs would prefer that the boundaries of the area health boards coincide with those of the individual boroughs.

Mr. Michael Barnes: Is it not the case that no representations have been made by the London borough of Hillingdon because that borough is very well satisfied with the fact, as I understand it, that it is to be a single area or borough health authority?
My borough—Hounslow—is very unhappy at the decision that it should be part of a three-borough area health authority together with Ealing and Hammersmith. Some London boroughs are very upset about this. I do not understand what the hon. and learned Member for Ruislip-Northwood (Mr. Crowder) and the hon. Member for Uxbridge (Mr. Shersby) are protesting about on behalf of their borough, because their borough has got what it wanted. I only wish mine had.

Mr. Crowder: It really will not do for the hon. Member for Southwark (Mr. Lamborn) to make a speech of the type he is making in the House if it has not been looked into carefully on behalf of the boroughs concerned. It is typical of the incompetence of the Labour Party. If there is a point to be made, let it be made firmly and squarely. To bring our borough into this—

Mr. Deputy Speaker: Order. Is this an intervention or a speech?

Mr. Crowder: As I have been asked a question, may I put it on the basis that——

Mr. John: On a point of order, Mr. Deputy Speaker. I realise that the hon.


and learned Member for Ruislip-Northwood (Mr. Crowder) comes to the House infrequently, so he may be a little unfamiliar with its practices, but is it in order for him to stand at the same time as my hon. Friend the Member for Southwark (Mr. Lamborn)?

Mr. Deputy Speaker: That is not normally in order, but I had called the hon. and learned Gentleman.

Mr. Crowder: I am obliged, Mr. Deputy Speaker. It is unfair for the borough which my hon. Friend the Member for Uxbridge (Mr. Shersby) and I represent to be dragged into this argument when it has not even been consulted.

Mr. Lamborn: I repeat that I cannot be responsible for the liaison that the hon. and learned Gentleman has with his borough. What is suggested is in line with what I have told the House.
1.0 a.m.
I am advised by the London Boroughs Association that it is the view of the London boroughs that the health board boundaries should be conterminous with the boroughs. If the hon. Member's borough already has a boundary which is conterminous with the area health board that does not in any way detract from the fact that all the London boroughs want their boundaries to do the same. That is the representation that has been made to me. It was the representation made to the Secretary of State in correspondence and in meetings and it is the representation which I on behalf of the London Boroughs Association am making in respect of the Bill.
I end on the theme on which I started. There is no case for saying that London should be treated differently from the district councils outside the London area. I agree entirely with the sentiments in the White Paper that it was desirable that the areas of the individual boroughs should coincide with those of the area health boards, and I hope that the Secretary of State will consider the position and see that London is treated the same as elsewhere.

Mr. David Waddington: I apologise for intervening in a debate which on the face of it would appear to be of concern only to hon. Members with London constituencies.

However, I could not for one moment support Amendment No. 132 because it would remove entirely the possibility of the Secretary of State deciding in a special case that there should be more than one area health authority in a non-metropolitan county. I refer, of course, to paragraph (c) of the proposed amended clause. I know that the White Paper envisaged that there should be only one area health authority in each non-metropolitan county but the Bill as drafted leaves the door wide open for the Secretary of State, if he wishes to lay an order providing that there could be even six separate area health authorities within the boundaries of a non-metropolitan county.
I want my right hon. Friend when he comes to laying orders concerning the non-metropolitan county of Lancashire to consider carefully the possibility of providing for more than one area health authority within that county. This is an important matter for North-East Lancashire. I shall not canvas all the arguments tonight because there may be another opportunity to do so. However, many representations have been made to the Secretary of State by local authorities in North-East Lancashire and by the Burnley District Hospital Management Committee. The local authorities in North-East Lancashire feel strongly that the county is too large an area to be served by one area health authority. They want local representation on the area health authority but they fear that on an area health authority of that size local interests might not be sufficiently well represented. The new Lancashire county is a very large area. It includes a population of 1·34 million.
The people in my part of the world are inclined to doubt the logic of a proposal—I refer to the proposal in the White Paper—which provides for area health authorities within the metropolitan areas covering populations of 200,000 or 300,000, whereas in the non-metropolitan county of Lancashire one area health authority would be required to serve the needs of 1·34 million people.
I will not develop the arguments further. I merely say that it would surely be wise, when all these issues of such great importance to the people outside London have been raised with the Minister, to leave the door open so that he could so provide, if, having considered


the matter further, he decided that there was a case for more than one area health authority in a non-metropolitan county.
I want to see the door left open. Perhaps unwittingly the hon. Gentleman would be closing that door if he were successful in having this amendment carried.

Mr. Barnes: I support the amendments of my hon. Friend the Member for Southwark (Mr. Lamborn), which are designed to create single-borough area health authorities in London.
I should like to cite the example of my own borough, Hounslow, to show that this is the best arrangement for the London area. Under the present proposals Hounslow is to be part of a three-borough area health authority comprising Hounslow, Ealing and Hammersmith. This will be a vast area of 700,000 inhabitants, whereas Hounslow, with a population that is increasing quite quickly—it is now 206.000 and rising—meets all the criteria which the Secretary of State has laid down for single-borough area health authorities.
Let us take first the criterion of the hospital catchment area. The majority of the patients treated at the West Middlesex Hospital are residents of Hounslow, and the remaining patients will still attend the hospital no matter what area health authority boundaries apply.
The services that make up the other criteria—community nursing, social services, education services, environmental health service—are based in the London borough of Hounslow, and the new civic centre now under construction is to be within a few hundred yards of the present health centre in Hounslow. The Hounslow health centre is one of the most revolutionary centres of this kind, certainly in this country and possibly in the world. General practitioner services, local authority health and social services, a mental health day centre, child guidance clinics, dental services, and family planning services are all provided under the same roof. The centre would make an obvious and ideal headquarters for a new area health authority based on the borough.
In addition to that Hounslow health centre, there are four health centres in operation in the borough and a further

two in an advanced stage of planning. Experience at them has been that the liaison between general practitioners and the local health authority has been very good and effective.
Hounslow is a very good example of why the London boroughs are very suitable to be single-borough area health authorities. Hounslow is a model health authority, and could easily become one of the new area health authorities with the minimum of change and disturbance. I believe that the same applies to every London borough. That is why I support my hon. Friend's amendments.

Mr. Marcus Worsley: I hope my hon. Friend the Under-Secretary of State will resist the amendment. I could not help wondering whether the hon. Member for Southwark (Mr. Lamborn) would apply the same argument to education. I should be surprised if he wanted to dismantle the Inner London Education Authority on the same principle.
The problems of many of the social services in the London area, particularly in central London, are different in particular. It would be the height of folly to have such a rigid system whereby we could only have area health authorities and boroughs conterminous. My borough would be in a difficult position if it had to be an area health authority. It is much better grouped with its neighbour, the City of Westminster, where there are so many teaching hospitals.

Mr. Pavitt: The case for the Inner London Education Authority is a very different set of arguments from those which apply in the case of the area health authorities, and that case was accepted in 1963 by the Secretary of State for Social Services himself when he was Minister of Housing and Local Government and introduced the London Government Act. The Conservative Government of the day saw the force of the amalgamation.
I support the amendment. The Committee understood the problems and difficulties the Department has had in trying to solve the problem of boundaries and areas. What fitted in one way did not fit in another. But I regret that, in the final analysis, when the pros and cons of why there should be amalgamations in the London area for area health


authorities have been considered, the predominant reason for the solution proposed in the Bill was that the right hon. Gentleman rested on the requirements of the organisation and administration of the hospital service.
The Bill is an attempt to get co-ordination between domiciliary and institutional care. That is one of its main purposes. The effort is being made to shift the present preponderance of resources from the hospital service into family service and community care. At present 67 per cent. of the total resources go to the hospitals. The amendment seeks to redress the balance.
The social services reorganisation which took place after the Seebohm recommendations caused enourmous upheaval in London. The changeover has led to a tremendous growth in most areas, particularly in Brent, my own borough, in the whole provision of social services.
The big problem which the Government have failed to solve in the Bill, and one of their greatest mistakes, is that with regard to divorcing the social services from medical care. In London this problem is becoming more acute because of the greater population and the disparities between the areas. We have had the Seebohm upheaval; now there is to he another.
At present, the director of social services and his department at the town hall or civic centre are cheek by jowl with the community physician, but now that normal kind of contact is to be taken away. It will be all right in my area, because we arc to marry Harrow, but I am afraid that Harrow will be dispossessed because it will not have the same kind of contact. There are great problems in marrying two areas with services already in existence.
1.15 a.m.
Of course the hon. and learned Member for Ruislip—Northwood (Mr. Crowder) is not worried. Hillingdon has got out OK. Incidentally, may I say how I admire the sheer insensitivity of the hon. and learned Member. Some of us have been sitting in the House since 2.30 this afternoon and he slides into that bench for a few minutes and makes an interjection which is recorded in

HANSARD just like the rest of our speeches. I admire his skill but I resent it very much as one who has sat here since 2.30 p.m.
The London Boroughs Association has had all the arguments put to it and has had representations from all of the 32 boroughs, including Hillingdon. Hillingdon was in on the discussions which took place.
Of course the Under-Secretary will put forward opposing arguments, especially about the difficulty of the alignment of other responsibilities which will fall within the comprehensive administration of what was a tripartite administration. The right areas are the local government areas because it will help when the next Labour Government turns this bureaucracy into democracy. London contains 8 million people, and if we could do this at this stage it will save the next Labour Secretary of State for Social Services a lot of headaches in dealing with a large section of the population. The next stage will be that much easier.

Mr. Mayhew: I warmly support the amendment moved by my hon. Friend the Member for Southwark (Mr. Lamborn) in respect of 31 out of the 32 London boroughs. I must disagree with him about my own borough. He tells me with great conviction that my borough has made representations to the effect that the area health authority should coincide with its own boundaries. I must assume, therefore, that since I spoke about this with the town clerk and the leader of the council and since I read the minutes of the council proceedings my local authority has changed its mind.
This is the only possible explanation I can give for my hon. Friend's insistence. If this is so I can only say that I think my local authority is mistaken if it has changed its mind. The disposition of the hospitals in Bexley and Greenwich make it a convenient area health authority. In addition, we have the special problem of the new town of Thamesmead being built partly in Bexley and partly in Greenwich. I would like to see this new town under a single health authority and not divided. With great respect to my hon. Friend, I support him in respect of 31 out of the 32 boroughs.

Mr. Alison: As the House is aware, the Government attach the greatest importance to securing, where possible, that the boundaries of the new area health authorities should match those of the new social services department authorities. This would best achieve the purpose of trying to integrate on the health side the old tripartite components of the National Health Service—the GPs, the hospitals and the local authority health services, and, having integrated the health side, to secure the closest possible interface with the local authority social services departments.
The House will be encouraged to know that in the plans for implementing reorganisation the matching of health and local social services authority boundaries which the amendments seek to secure has been achieved in all but one of the areas outside London. A one-to-one match would be our uniform objective in London, the exception to the rule, if it were practical. There were a number of factors which led us to the conclusion, after the most careful and extensive consultations, that this would not be the pattern that would best enable the new authorities to discharge their responsibilities of identifying health needs, collaborating with local government services and providing facilities in support of medical education.
I take here the point made by my hon. Friend the Member for Chelsea (Mr. Worsley). There are some very special factors in London. In November last my right hon. Friend announced the proposed area boundaries for London so that joint liason committees could be established to prepare for reorganisation. The pattern, as the hon. Member for Southwark (Mr. Lamborn) reminded us, consists of 16 areas: four comprising three London boroughs, and in one case also including the City; four areas consisting of single boroughs, and a number of hon. Members have expressed appreciation that they have come within this fortunate group; and eight areas consisting of two boroughs. The provisional proposals in Appendix 1 of the Green Paper emanating from the previous administration were for different individual groupings but also contained a combination of three-borough and two-borough areas and single boroughs. The last administration found the same dilemma as we found.
This pattern of areas was designed to strike a balance between unavoidably conflicting considerations in the London context, and, taking the needs of one borough with another, to give the greatest overall advantage to the National Health Service and the local authority service. It was arrived at after the most careful study and very wide consultations. In February my right hon. Friend considered very carefully strong representations made to him by the London Boroughs Association at a conference which he attended, and in writing to him afterwards. He went thoroughly over the ground which had been covered by the London Practice Group, so called, chaired by the Minister of State, following in the footsteps of his predecessor, Baroness Serota. After considering again all the arguments, including those on behalf of the health service authorities, and representations of the local authorities and family practitioners who made suggestions for larger areas, not smaller ones, my right hon. Friend concluded that the right course was to adhere to the pattern which he announced in November.
It will, of course, be possible to adjust the boundaries in the light of experience—I hope the House appreciates this—and in the light of changing circumstances, but at the inception of the service the boundaries which my right hon. Friend announced will, we believe, best serve its needs. The clause is flexible enough to enable alterations to be by order; we are not laying down a statutory pattern.

Mr. Nigel Spearing: I did not quite catch the allusion to the larger area. Did the hon. Gentleman say it was the hospital requirement which militated against the grouping of three, to which my hon. Friend the Member for Brent-ford and Chiswick (Mr. Barnes) referred? The London borough of Ealing is one which is in a unit of three. If the hon. Gentleman is now saying that after review there might be change it would be good to know it was on the basis of the hospitals rather than the general practitioner service.

Mr. Alison: I said the local authorities wanted smaller areas. There was contrary advice from authorities responsible for health services, including the general practitioner service in London. They preferred to have larger groupings of boroughs rather than smaller ones.
As I said, the Bill does not lay down a pattern; it gives powers to make orders and thus gives real flexibility. So the die is not finally and irrevocably cast, but this is the pattern my right hon. Friend decided on for the inception of the service. There is no ideal pattern for organisation of the health services in Greater London. Whatever we do people will be free to cross any boundaries we create and to use the services they want to use. It is a question of striking a balance, the least damaging compromise we can arrive at. Against this background the amendment would mean rigidity, inflexibility, which, in our judgment, would be unacceptable. I must regretfully ask the House to reject the amendment the hon. Member so eloquently moved.

Mr. John Silkin: My hon. Friends and I in Committee pointed out the enormous difficulties and ludicrous situations that arise from the whole concept of the proposed reorganisation of the health services. This is another example of the stupidity of the proposed reorganisation. The Under-Secretary of State called it the least damaging compromise—the least damaging of several damaging compromises, I suppose. The House will soon have to return to this when another reorganisation takes place
What inevitably flows from this is the total divorce of the health services from the social services at local level My hon. Friend the Member for Woolwich, East (Mr. Mayhew) may well be right when he considers Greenwich and Bexley in the context of hospital location, but he will be wrong when he comes to consider the local social services, after reorganisation, including his pet love, the treatment of the mentally handicapped.
I beg the House to consider this and to watch developments carefully. I am fearful of what will happen in London perhaps more than anywhere else in the country.

Amendment negatived.

Clause 7

FUNCTIONS OF AUTHORITIES

Mr. Alison: I beg to move Amendment No. 9, in page 6, line 30, leave

out from beginning to 'it' in line 38 and insert:
`in accordance with regulations:—
(a) to administer, on behalf of the Area Health Authority by which the Committee was established, the arrangements made in pursuance of the Health Service Acts for the provision of general medical services, general dental services, general ophthalmic services and pharmaceutical services for the area of the Authority; and
(b) to perform such other functions relating to those services as may be prescibed; and if'.

Mr. Deputy Speaker (Sir Robert Grant-Ferris): With this we can take Amendment No. 8, in Clause 5, page 5, line 1, after 'Act', insert:
'and as a sub-committee of such Area Health Authority.'.
and Government Amendments Nos. 10 and 12.

Mr. Alison: The purpose of the amendment is to give some express indication on the face of the Bill of the functions which are to be conferred on family practitioner committees by regulations under Clause 7 (3).
As I explained in Committee at the Eleventh Sitting in columns 602–604, the functions of family practitioner committees which are to be prescribed under Clause 7(3) will consist mainly of entering into individual contracts with the family practitioners, administering their terms of service, including nationally-settled remuneration schemes, and the statutory disciplinary arrangements, which will remain as before. On matters which involve other parts of the health service, primary responsibility will rest with the area health authority, by virtue of the amendment made to the earlier National Health Service Acts by Schedule 4, so that those aspects of the family practitioner service can be suitably integrated within the reorganised and unified health service.
This amendment is not intended in any way to alter the division of functions between the area health authority and the family practitioner committee which I have just outlined. Nor, on the other hand, does it mean that the precise division of functions that we decide upon now is one to which we shall be permanently committed. The clause will provide, as now, the necessary measure of flexibility for changes to be made by


amending regulations in the light of experience. The effect of the amendment is simply that, whatever detailed changes may be made by subsequent regulations in the functions of family practitioner committees, they will at least retain the basic functions set out in paragraph (a) of the amendment. Any proposal to take those functions from them would require an Act of Parliament.
The Government have put down the amendment in response to representations from the General Medical Services Committee and bodies which represent the other professions providing the family practitioner services—representations to which the hon. Member for Liverpool, West Derby (Mr. Ogden) briefly referred in Committee. These professional bodies have understandably been very concerned lest the Bill, in providing the flexibility needed for integration and development of the reorganised service, might—even though unintentionally—have weakend the legislative safeguards of their status as independent contractors, which is of course a cardinal feature of our NHS, and one to which the professions attach great importance—I notice the smile on the face of the tiger—the hon. Member for Willesden, West (Mr. Pavitt). They particularly had in mind that some future amendment of the regulations to be made under Clause 7(3) might leave family practitioner committees nominally in existence but without any effective functions to carry out.
As my right hon. Friend has explained to the professional bodies, the independent contractor status of their members in providing family practitioner services is enshrined in the earlier NHS Acts, and is not affected by any provision of the Bill nor would it be necessarily diminished even if the functions of family practitioner committees were to be eroded in the way the professions feared. Nevertheless, as I made clear in the debate on Amendment No. 8, we regard the family practitioner committee, with its special constitution and its direct access to the Department, as an essential part of the integrated service, and one which successive Governments have undertaken to establish. I accordingly commend the amendment to the House as one which ensures a continuing role for the family practitioner committees without in any

way reducing the scope for integration and development of the service which is secured by the other provisions of the Bill.

Amendment agreed to.

1.30 a.m.

Mr. Deputy Speaker: Amendment No. 10 can be dealt with formally.

Amendment proposed: No. 10, in page 6, line 39, after 'preceding', insert 'provisions of this '.—[Mr. Alison.]

Mr. John Silkin: On a point of order, Mr. Deputy Speaker. I think some confusion has arisen because of the fact that in the selection list Amendment No. 9 precedes Amendment No. 8, and I think that my hon. Friend the Member for Halifax (Dr. Summerskill) intended to speak to Amendment No. 8. The speed with which we are proceeding temporarily caught her unaware.

Mr. Deputy Speaker: I am in a difficulty. I put the Question on Amendment No. 9 and I have taken that decision. Amendment No. 8, which preceded it, was grouped with it by Mr. Speaker for discussion but not for division. Therefore, if any hon. Members had wanted to speak on Amendment No. 8, I was expecting them to rise to their feet while we were discussing Amendment No. 9. I think I detected a misunderstanding on the part of the Under-Secretary of State, who thought that he would be answering the hon. Lady the Member for Halifax (Dr. Summerskill). However, the situation cannot be changed now and I am afraid the opportunity has been missed. It is normal procedure to group matters for discussion, and, having collected the voices and disposed of the Question, I cannot go back on that. I am willing to hear another point of order on the matter.

Mr. John Silkin: On a further point of order, Mr. Deputy Speaker. Would it be possible for Amendment No. 10, which would otherwise be taken formally, to be taken separately and for there to be a little latitude in the rules of order to accommodate my hon. Friend the Member for Halifax?

Mr. Deputy Speaker: I accede to the right hon. Gentleman's request.

Dr. Summerskill: I am grateful to you Mr. Deputy Speaker, for your latitude. I shall attempt to speak to Amendment No. 10, which deals with the family practitioner committee. I cannot refer specifically to my amendment by which we should like to set up a family practitioner committee as a sub-committee of the area health authority, but I wish to express our general dissatisfaction with the Government's justification of the family practitioner committees as they appear in the Bill.
The explanation given in Committee by the Under-Secretary of State was far from satisfactory and remains so. He has seen fit to respond to an amendment from the General Medical Services Committee and we regret that he could not see fit to respond to criticism we made in Committee. We still feel that this is, as he once said himself, a titular desecration Bill, or rather, that many aspects of it are titular desecration. The executive councils, although they have been deprived of some of their functions, remain much as before under another name.
We are left with the retention, if not of a tripartite system, of a bipartite system where we have family practitioners separated from hospital practitioners, hospital doctors and hospital pharmacists in these committees.
The basic philosophy behind this is a belief that family practitioners are independent contractors, but on this side we question for how long they will remain so. They are not as independent as they used to be from the point of view of the way in which they receive their salary.
Among many doctors there exists a view that the future of the family practitioner is as a salaried officer in a health centre. There is excessive emphasis on appointment within the family practitioner committees, in that 11 will be appointed by the area health authority and the rest will also be appointed. It is questionable how much these committees will be acceptable to the public, known to the public and accountable to the public. They will not be at all. They will not even be accountable to the area health authorities. They will deal directly with the Minister.
Other functions of the area health authorities, such as setting up health centres, family practitioner premises and

helping family practitioners will not be under the family practitioner committees, so there is this division of powers, some being with the area health authorities and some with the family practitioner committees, and yet the accountability of the family practitioner committees will be totally to the Minister, so the arrangement under the Bill is rather anomalous and certainly undemocratic.
It will require co-operation from doctors to play this new and positive rôle which is the pride of the Government in presenting this Bill, but I wonder whether doctors will have the time or the wish to co-operate as the Bill will require.
There is no doubt that strong reservations have been expressed by the Secretary of the British Medical Association in the British Medical Journal and at the recent Folkestone conference.
We were left, at the end of the Committee, in some confusion as to the exact role which the various teams will play. We were told that there will be health care planning teams below districts which will review primary services and these will float up ideas to district management teams, and they in turn will float up ideas to the area health authority.
This sounds reasonable. I shall not say that the committee sounds any more reasonable but I wonder whether in practice it will operate efficiently or whether these bodies will have the power we should like them to have. We are told that they will be more powerful than family practitioner committees, but that remains to be seen.
We are also told that the Bill makes provision for an area health authority to interchange its functions with family practitioner committees and vice-versa. Certainly that gives scope for a great deal of alteration in the future, and it is difficult to comment on that until we know exactly what will be entailed. Much will depend on the Government of the day and how they use that scope.
It seems that these family practitioner committees do not provide a patient-oriented service. We had hoped for some Government amendments on this aspect. The Under-Secretary told us that the family practitioner committee is an extension into the new organisational set-up of a philosophy which was considered right back in 1946 by the late


Aneurin Bevan to be a reasonable one in the context of the professions. But the Opposition are not living in 1946 any more. We are living in 1980, 1990 and even 2000 when planning this Bill. It is no justification to say that because it was all right in 1946 it is all right for this Bill.
The Bill continues to be a regressive measure. Opportunities have been missed, and the amendment was a simple and workable alternative.

Mr. Alison: The hon. Member for Halifax (Dr. Summerskill) has again expressed the fear which she and her right hon. and hon. Friends have and which runs wider than the amendment upon which she was precluded from speaking, that the arrangements in the Bill would isolate family practitioners from other parts of the integrated health service and would limit their impact upon developments and plans which affected them.
I understand and respect those fears about the future integration of the family practitioner committees. It is a novel attempt to weave into a single fabric elements which in the past have been quite separate and disparate. But I have no reason to believe that a family practitioner committee will not work closely with its area health authority which, after all, will have appointed more than a third of the members of the committee.
Unlike executive councils, family practioner committees will not be fully distinct organisations. They will use staff and premises provided by the area health authorities. I believe that they will be effectively integrated, if only by these means.
I explained that the functions of the family practitioner committees which are to be prescribed under Clause 7(3) are simply the traditional and recognised functions connected with the individual contracts of these independent contractors. But on matters involving other parts of the health service, primary responsibility will rest with the area health authorities, so that those aspects of the family practitioner committee services can be suitably integrated with the reorganised and unified health service.
I am confident that, given the special disposition of staff, premises, the powers of the area health authorities to give

directions, and so on, and given this narrow limitation on matters affecting the contract, we shall secure to an unprecedented degree and in tune with the needs of the 1970s and 1980s a real integration of the old executive council functions in the reorganised service and the hon. Lady's fears will, I hope and believe, prove to be groundless.

Mr. Pavitt: I do not share the hon. Gentleman's optimism. As I said in Committee, I believe that this is one of the major mistakes in the Bill, simply by not having it as an integral part of the rest of the machinery.
The Under-Secretary has made it clear that however persuasive our arguments in Committee about the fact that this should be incorporated as a sub-committee of an area health authority, they have not had the slightest effect. However, when the General Medical Services Committee presses the hon. Gentleman, he immediately accedes to that pressure and finds an amendment to meet the point.
I am in some difficulty because of the procedural trouble that we have had. I was looking forward to surveying the House from the Dispatch Box tonight. I have almost succeeded on nearly two occasions. However, before dawn it may be that I shall have an opportunity to do so. Circumstances have not permitted me to do it on this occasion, but I should dearly have loved to.

Amendment agreed to.

1.45 a.m.

Mr. Alison: I beg to move Amendment No. 11, in page 7, line 26, after 'section', insert
'or by an Area Health Authority by virtue of Part IV of the principal Act;'.
The purpose of the amendment is technical. It is to fill an unintentional gap left in the Secretary of State's powers of direction.

Amendment agreed to.

Amendment made: No. 12, in page 8, line 17, leave out 'or (4)'.—[Mr. Alison.]

Clause 8

LOCAL ADVISORY COMMITTEES

Mr. John: I beg to move Amendment No. 13, in page 8, line 22, leave out from


'persons' to 'it' in line 29 and insert
'in any substantial category of workers in the health service'.

Mr. Deputy Speaker: With this amendment we will take the following amendments: No. 14, in page 8, line 28, at end insert
'Or
(f) the scientific and research workers in the health service in the region'.
No. 15, in page 8, line 45, leave out
'the Secretary of State may'
and insert
'it shall be the duty of the Secretary of State to'.

Mr. John: It may be of help if I speak about each of these amendments when dealing with Amendment No. 13.
Clause 8, as it stands, forms local advisory committees for certain categories of workers in the National Health Service. As originally drafted, it divided people who work in the health service into two categories. The first category is an élite, mentioned in subsection (1), for which a local advisory committee is, of necessity, to be recognised by the Secretary of State. The second category is another representative body which had to pass many hurdles and, even then, was permitted to be recognised only if the Secretary of State felt it right to do so.
I therefore welcome Government Amendment No. 15 in which the Secretary of State has conceded that any category of persons who fulfil the twin functions laid down in subsection (2)"shall" be recognised by him instead of "may". I referred to this point in Committee. Therefore, I am grateful that to that extent the right hon. Gentleman has been able to meet it.
I stress that this is a small advance in the concept of the health service as it is developing. It is no longer good enough to divide the categories of people who work in the health service. Common tribute has been paid to the integrated work of the health service in these days. We have heard how dependent each category of worker in the health service is upon every other category who service or back up the expertise of a particular person. The surgeon could not work without the laboratory technicians, and he certainly could not work without the biologists and various other categories who provide technical and other data for

him. Certainly for the clause to distinguish between certain named categories, who enjoy the privilege of having their wants automatically acceded to by the Secretary of State, and other people in the health service is to draw an invidious comparison in professional services which I believe are steadily growing together.
I do not believe that there are rigid demarcations in attitudes between senior consultants and, for example, laboratory technicians. Therefore, we must try to encourage the narrowing of that gap, because in every special sphere there are highly skilled and knowledgeable people who can impart their expertise in advice to the Secretary of State. So Amendment No. 14 is an attempt to recognise the contribution of the scientific and research workers in the health service in the regions.
The Under-Secretary said that not only is the category of professions ancillary to medicine a large one, larger than we could ever hope to list, but it is constantly changing and growing. It is worth reminding the House that we are talking about physicists, biologists, mathematicians and psychologists. I understand that there are as many as 1,200 clinical biochemists in the health service, and their expertise could be available to the Secretary of State.
The hon. Gentleman said that the purpose of the advisory committee was not to represent the service interests of the groups of workers but to advise on the best interests of the patient. But in the fields in which they are competent, there is none who can tender better advice on their specialities than committees of the scientists and research people themselves. Therefore, the acceptance by the Minister of Amendment No. 14, partial though it is, goes some way towards filling the long-standing need for recognition of these people and their rôle in the National Health Service.
After all, the Under-Secretary paid these people many encomiums about their role in providing a valuable health service. But it is not enough to be sentimental and say "We are one big team, chaps" when recognition is given to dental practitioners, medical practitioners nurses and ophthalmic technicians while the biologists and physicists must come


within a lesser category, with lesser status.
But even Amendment No. 14 would not fully meet our view of the developing health service, which is that any substantial category of workers should be able to form local advisory committees which will be recognised by the Secretary of State and turned to for advice by the Secretary of State. Our concept of the health service is that it is one whole, that the doctor depends on the theatre attendant, the hospital porter and every other person.
Although it might be said that the advice of some of these people is not very valuable on the working of the health service, I would reply that often the theatre attendant and hospital porter know far more about the working of a hospital and what is needed to improve the service than the specialist who comes for a brief period and then goes off again.
Therefore, Amendment No. 13 has two merits. First, it avoids any list and, therefore, any embarrassment caused by the omission of any category. Second, it recognises that an integrated health service is vital to its future development.

Mr. Lomas: I am in some confusion. I agree with what has been said about Amendment No. 13. Any substantial number of people in the National Health Service must include the large body of ancillary workers, so why we have decided in Amendment No. 14 to add yet another section to the élitism which has been mentioned and divorce it from the theatre attendants and porters I do not understand.
It seems a most peculiar situation.
The best way out would seem to be to accept Amendment No. 13 and simply say that
Where the Secretary of State is satisfied that a committee formed for the region of a Regional Health Authority is representative of persons in any substantial category of workers in the health service … it shall be the duty of the Secretary of State to recognise the committee
and so on.
I object to tributes being paid to ancillary workers, hospital porters, theatre attendants, and the rest, for the great work they do, yet when there is an opportunity of giving them a chance to serve

not only the health service but the nation we cut them off. That is wrong.
There is a contradiction here. It seems quite wrong to add just one group. If the hour were not so late I should be inclined to tell my right hon. Friend the Member for Deptford (Mr. John Silkin)—I rarely disagree with him, and I served under him when he was Chief Whip and in his numerous other capacities—that I recognise his logical thinking but that in this instance he has gone astray. It would be wrong to add to this élitism. We should include representatives of all sections of the health service and not pick out medical and dental practitioners, nurses and midwives, registered pharmacists, and ophthalmic and dispensing opticians, and then add a few more. We want those who can be of most benefit to the service. Why chop off at the professions and draw a line there, saying "Those below this line can do the donkey work but cannot be represented on these committees"?
When we conclude the debate on the Amendments I hope that the Minister will accept Amendment No. 13. I would reject Amendment No. 14, if the hour were not so late, because it brings in one more elite sector. If I am any judge of what my party has been thinking about for the last 30 years of the health service, this is exactly what it wants to get rid of. I am not thinking of the historical connotations. We are concerned with the new health service. This is a reorganisation of the health service. For that reason, if we are to have categories of people who are to serve on committees, ancillary workers and such people should be included, and we should use the simple overall phrase "any substantial category of workers in the health service". That would recognise the fact that those who work in the theatres as porters and in other essential jobs ought to be taken into account in decided who should be appointed to various committees. It is no use drawing lines. I appeal to my right hon. Friend to press Amendment No. 13 and not to move Amendment No. 14. I hope that he will also agree to Amendment No. 15.

2 a.m.

Mr. Alison: If it is not presumptuous of me, I should, perhaps, start by congratulating the hon. Member for Pontypridd (Mr. John) on his maiden speech


as official Opposition spokesman. I would celebrate it with champagne if it were in order, but it is not, alas—so I shall do the next best thing. I shall move Amendment No. 15, which is a Government Amendment selected with this group and gives effect to the promise which I made to the hon. Gentleman in Committee.
The amendment makes it mandatory, instead of permissive, to recognise any committee representing a category of persons, other than members of the five key professions, where my right hon. Friend the Secretary of State is satisfied that it is representative of that category and that recognition is in the interests of the health service. The amendment also has the effect of making it mandatory, on similar conditions, to recognise a committee representing two or more categories of workers.
I hope that the hon. Member for Pontypridd will recognise this as a fair response to the argument that he used in Committee and as the nearest thing to a glass of champagne that I can offer him on the occasion of his maiden appearance at the Dispatch Box on this subject.
But I must now sound a slightly more doleful note in coming to the other amendments. The general objective of Clause 8 is to set up machinery by which the views of the professions directly concerned in patient care can be made known to health authorities. This could be secured by including in the clause a comprehensive list of all groups whose advice it might conceivably be of advantage to the health service to seek through the medium of committees representing those groups. This would be cumbersome and would make for rigidity. Alternatively, the clause could avoid specifying any particular groups and this is in effect what the amendment would do. This would be unsatisfactory in turn because there would be no certainty that the professions for which advisory committees are clearly needed would all be represented in all regions or areas. Moreover, there would be difficulty in defining what is a "substantial category of workers".
The clause as drafted achieves a compromise in the recognition of advisory committees where the need for these is already clearly established, while providing, in Clause 8(2), for any other professions or groups to be added where

this is considered to be in the interests of the service. This arrangement achieves flexibility while at the same time ensuring proper representation of professions with a key rôle in advising management authorities.

Mr. John: I am sorry to repay good by evil, but the hon. Gentleman must not make points which are not valid in trying to reject the amendments. His point now, as I understand it, is that if we do not specify paragraphs (a) to (e) in Clause 8(1) it could be that people who ought to be represented will not be recognised as a committee for a particular reason. That is only so if the Secretary of State refuses to recognise them. But it would be the duty of the Secretary of State to recognise such a category under our amendment and that seems to admit of no doubt that such people would have their committees recognised along with all others.

Mr. Alison: It is the vagueness of the omnibus term which the hon. Gentleman's amendment uses which puts us in a difficulty. It is the general reference to a "substantial category of workers".
The distinction between subsections (1) and (2)—I stress this again because it is important—is not one between staff whose services are regarded as valuable and staff whose services are not so valuable—second-class staff, as I think the hon. Gentleman put it. It is simply a distinction between those services for which the health authorities must have expert advice, in order to be able to discharge their functions, and other services. The purpose of the advisory committees is, therefore, not to represent the service interests of groups of workers—I make this point in response to the arguments used by the hon. Member for Hudders-field, West (Mr. Lomas)—professional workers or otherwise, because there is established machinery for representing the interests of groups of workers. It is simply to make available to regional and area health authorities expert advice as to how the interests of patients can best be served.
Clearly, in this context the advice of doctors, dentists and nurses, and so on, must be forthcoming. That is not so necessary in the interests of patients in the case of other workers, but if in any region or area it can be shown that


this is so, then under subsection (2), as amended by Amendment No. 15, committees representative of such workers can and will be recognised. There is, therefore, all the needed flexibility. It is on this basis that we must ask the House to reject Amendment No. 13.

Mr. Pavitt: Is the Under-Secretary saying that the advice which he can receive from large sections other than the professional people is of no importance in the National Health Service? Who knows more about it than those working in the service in a number of different capacities? Surely their advice, as I was able to demonstrate in Committee when I instanced the case of a hospital board and a hospital management committee, is invaluable.

Mr. Alison: It is indisputable that the interests of patients demand that the immediate curing and healing professions should be able to proffer professional advice, but we do not exclude anybody. If other groups are held to be relevant to the needs of patients, they can be brought in by subsection (2).
As for Amendment No. 14, as I explained, it is not practicable to specify in subsection (1) all the categories of persons whose advice might at some time or other be needed by health authorities. It is necessary to draw a line somewhere. I submit that the criterion we have used, in aligning the list initially with the healing professions directly responsible for patient care, is a reasonable one.
It is going rather beyond this immediate first list to add scientific and research workers to the five categories who must be included. The hon. Member for Huddersfield, West demonstrated the difficulty of trying to add any more categories to the immediate short list we have prescribed in subsection (1).
Our adoption of the criterion to which I have referred in no way reflects upon the importance of the work of scientific staff in the functioning of the service or indeed upon that of other professional or non-professional groups all of whom contribute to the effectiveness of the National Health Service.
I stress that the list in subsection (1) is the initial and basic list. Subsection (2) provides for committees representative of other categories, which could of course

include scientific and research staff, to be set up and recognised where the Secretary of State is satisfied that this is in the interests of the service.
I urge the House to accept Amendment No. 15 and to reject Amendments Nos. 13 and 14.

Mr. John Silkin: The speeches of my hon. Friend the Member for Hudders-field, West (Mr. Lomas) and of the Under-Secretary to a great extent illustrate the difficulty we are in and which I thought my hon. Friend the Member for Pontypridd (Mr. John) succeeded in putting to the House very eloquently at this late or early hour of the night or morning depending on which way we look at it.
The difference between subsections (1) and (2) is that subsection (1) lists categories which the Secretary of State believes are essential to the running of the National Health Service and subsection (2) tells us that there may be categories which are of assistance to the running of the health service but that at present the Secretary of State does not know what they are.
My hon. Friend the Member for Huddersfield, West delivered a very courteous, though justified, lashing to myself. We have forgotten the pilot. Health service workers are a vital category. Therefore, I should like to think again about this. When I discussed these amendments with my hon. Friends I was looking at the categories in subsection (1). There seemed to me to be a glaring omission in the case of the scientific and research workers to whom my hon. Friend so eloquently referred. They are a large and influential group of health service employees. Many of them have medical qualifications as well as scientific qualifications. Therefore, the list did not seem to be complete.
I am not satisfied with the Under-Secretary's definition of healing. In that sense, is a pharmacist somebody who heals or somebody who provides the means by which healing is achieved? The two things are rather different. If we go to that extent, we must include scientific and research workers.
Under subsection (2) we are dealing with groups of people whom the Secretary of State under his powers does not at present recognise but whom he thinks might become recognisable in future.
From that point of view we can see that we are right up against the problem of the health service worker. I therefore accept my hon. Friend's rebuke, which is right and justified, and I wish that in the same spirit the Under-Secretary could accept Amendment No. 13. If he were able to do that I should be willing not to press Amendment No. 14, which would be subsumed in it.
This shows, first, the weakness we all have for trying to categorise those who serve the health service. This is not a finite list. It goes on increasing. Secondly, perhaps we have, and this may have been inherited from 1946—a some-what élitist view of the health service and perhaps it is time we changed our minds and became more realistic.
I suggest therefore that if the Under-Secretary, or even the Secretary of State, whom we are glad to see here, were to ask the leave of the House to reply further, having given even more consideration to the matter, we should be very glad to welcome that familiar voice again.

Amendment negatived.

Amendment made: No. 15, in page 8 line 45, leave out
'the Secretary of State may'
and insert
'it shall be the duty of the Secretary of State to '.—[Mr. Alison.]

Clause 9

COMMUNITY HEALTH COUNCILS

Mr. Alison: I beg to move Amendment No. 17, in page 10, line 34, leave out
'appointment of a chairman of a'
and insert
'election by members of a Council of a chairman of the'.
The effect of the amendment is to secure that the chairman of a community health council is elected by the members of that council.

Amendment agreed to.

Mr. Arthur Blenkinsop: I beg to move Amendment No. 18, in page 10, line 37, at end insert:

'(provided that no regulations made in pursuance of this paragraph shall permit the staff, premises or expenses of councils to be provided by or shared with any Area Health Authority)'.
I feel a certain chill wind blowing through the Chamber both physically and, I suspect, intellectually. We on this side have clearly expressed our dislike of the community health councils. We do not think that they are an adequate means by which public opinion should be expressed about the health service, but still we battle on in a manful way to try to get modest amendments made, to make the Bill less disagreeable and to improve its provisions.
So this modest amendment is brought back before the House at this disgraceful hour of the morning because we were so dissatisfied with the treatment afforded to the proposal in Committee. When this issue was discussed the Minister seemed to make the case that our amendment was attempting to limit the ability of the new councils to appoint such staff as they wished because there was this limitation included in the amendment. If the Minister had made it clear that he was willing to agree to write in his own amendment giving full power to the councils to choose their own staff, premises and so on, none would have been happier than we, but he did not. I put down amendments that would have achieved that object, but they were not selected, so we cannot discuss them. If the Secretary of State would say that he is willing to substitute the same proposals, even with a manuscript amendment, giving the new community health councils authority to choose their own staff and premises, we should be very pleased.
2.15 a.m.
This is a much more modest proposal that merely tries to avoid the major disadvantage under which it would be possible that the staff and premises might be those of the area health authority, in which case we believe there would be a complete loss of any real sense of independence. This is very much the view of the local authorities. I have had a further communication from them in which they repeat that they very much dislike the present provisions. They would prefer to see local authority staff premises used. They particularly dislike


the proposal that the body that is to be, as it were, investigated might provide the staff.
I have heard not only from the Association of Municipal Corporations but from the National Council of Social Service, which confirmed the same anxieties about the present provisions and asked for an amendment.
I do not understand why the Secretary of State cannot accept the amendment or comparable provisions bringing the position somewhat nearer to our view. We regret that after the discussions in Committee he has not made any proposals of his own on Report. We should have understood if he had made definite proposals himself, but he has not. I hope that even at this stage he will agree to the modest provision that we propose, which would go some way to meet not only our anxieties but those vigorously expressed by the local authorities and such a body as the National Council of Social Service.

Mr. Mayhew: My hon. Friend the Member for South Shields (Mr. Blenkinsop) was very right to move the amendment and to show the concern that is widely felt at the balance of power between community health councils and the area health authority. Many of us have felt this for a long time, but today I feel a new concern, having learnt of the Secretary of State's intention not to call for nominations for the community health councils until next April. I did not realise the implications before. Is this so? Is it the right hon. Gentleman's intention that the area health authority and the regional health authority should begin operations without any community health council to check them? For how long are we to have area and regional health authorities operating without any kind of accountability or watchdog function or democratic control?
It behoves us to press amendments of this kind in efforts to make more powerful the position of the community health councils. I do not know whether it is the intention of my hon. Friend the Member for South Shields to press the amendment to a Division, but we should have from the right hon. Gentleman an explanation and a reassurance that he does not propose to launch the area and

regional health authorities without any form of watchdog or democratic supervision.

Sir K. Joseph: The hon. Member for South Shields (Mr. Blenkinsop) has invited me to go over ground extensively covered in Committee. The substance is that the Government and the Opposition believe that community health councils should make their own decisions on staff and, subject to what I am going to say, on premises. I do not see that as limiting their freedom of decision. It makes sense that they should be allowed to consider the staff offered to them by the regional authorities; if they do not like that staff, they will say so. It also makes sense that they should consider the premises offered by the authorities; if they do not like those premises, they will say so.

Mr. Blenkinsop: If the right lion. Gentleman takes that view, why does he not put down an amendment to specify precisely that?

Sir K. Joseph: Because this sort of thing is spelt out in regulations and I am asserting that that is our intention. I am also asserting that we think that the right staff should be culled or chosen from people who are in the NHS as a career. That will normally be the position because the community health councils will be best served by people who know their way around the NHS, understand the statistics and can make effective use of the information necessary to the community health councils and their decisions.
We assert, and I repeat, that the community health councils will be able to say "We do not want that person but someone else." The same will be true of premises. From time to time, a council will no doubt choose to share premises with an area health authority because that is more sensible. I do not see why we should take away the freedom of the councils to make up their own minds. We share the desire to see the community health councils independent within this framework.
The hon. Member for Woolwich, East (Mr. Mayhew) is right that our date for having community health councils in operation will be 1st April 1974. But, unlike the regions and the areas, we do not have to have them in operation in


shadow form or in substantial form long before in order to prepare the management of the new service. They will be called into action when the new service begins. I hope the hon. Gentleman is reassured.
I hope that the hon. Member for South Shields will not press the amendment. If he does, I must ask my right hon. and hon. Friends to reject it.

Mr. Pavitt: The right hon. Gentleman's explanation is totally unsatisfactory. He knows the argument well. The amendment seeks to set up a watch-dog, not a kept poodle. The amendment aims to get the whole organisation from under the control of either area or regional authority. Without the assurance of this amendment we have no guarantee that the regulations will contain what we seek.
In the Grey Book it has been made plain that officers of the community health council will be a part of the career structure within the area health authority. Full-time officials serving community health councils will, if they are looking for promotion, be reluctant to get at cross purposes with the area or region. This is the point of the amendment. We have to keep officers, premises and so on independent of those over whom they are supposed to be watching. This is the only way they can effectively perform the function which the right hon. Gentleman envisages. The right hon. Gentleman ought to assure us that when he frames his regulations he will have second thoughts and include this guarantee.

Sir K. Joseph: I undertake that in the regulations, when they are made, I will seek to embody the assurance I have given to the House. I cannot go further.

Amendment negatived.

Mr. Mayhew: I beg to move Amendment No. 19, in page 11, line 29, leave out 'and'.

Mr. Deputy Speaker (Mr. E. L. Mallalieu): With this we can also discuss Amendment No. 20.

Mr. Mayhew: These amendments would prevent overlapping of membership between community health councils on the one hand and regional and area health authorities over which they are supposed to he watch-dogs on the other.

It is self-evidently sensible, and I challenge even the Secretary of State or the Under-Secretary, who are well known for their ingenuity in these matters, to find good reason for not accepting the amendments.

Sir K. Joseph: The hon. Gentleman has almost stimulated me to find a reason for rejecting the amendments. Such is the spirit of co-operation at this hour that I will tell the House that it was the Government's intention to do exactly as the hon. Gentleman suggests in regulations. It would make sense to accept the amendments.

Question put and agreed to.

Amendment made: No. 20, in page 11, line 32, at end insert:
'and
(d) no member of the Council is also a member of a Regional Health Authority or Area Health Authority'.—[Mr. Mayhew.]

Mr. Alison: I beg to move Amendment No. 21, in page 11, line 38, at end insert:
'(5A) The Secretary of State may by regulations—
(a) provide for the establishment of a body—

(i) to advise Councils with respect to the performance of their functions and to assist Councils in the performance of their functions, and
(ii) to perform such other functions as may be prescribed; and

(b) make provision as to the membership, proceedings, staff, premises and expenses of the said body;
and the Secretary of State may pay to members of the said body such travelling and other allowances (including compensation for loss of remunerative time) as he may determine with the consent of the Minister for the Civil Service.'.
This amendment discharges the undertaking given in Committee to consider amendments moved by the right hon. Member for Deptford (Mr. John Silkin). Its effect is to give the Secretary of State power to provide by regulations for the establishment of a national body which would advise community health councils with respect to the performance of their functions, and perform such other functions as may be prescribed.
The Secretary of State will also have power to make provision as to the membership, proceedings, staff, premises, and expenses of such a body and to pay to members of the body such traveling


and other allowances as he may determine with the consent of the Minister for the Civil Service.
The hon. Member for Woolwich, East (Mr. Mayhew) will recall the intervention he made in my speech during Second Reading. He suggested that a national organisation of community health councils might be a good idea. This is the end product of the germinal idea which he sowed in the minds of hon. and right hon. Members at the time.

Amendment agreed to.

Clause 10

CO-OPERATION BETWEEN HEALTH AUTHORITIES AND LOCAL AUTHORITIES

2.30 a.m.

Mr. Alison: I beg to move Amendment No. 22, in page 13, line 18, at end insert:
'or to join with another joint consultative committee or other joint consultative committees in appointing a joint sub-committee'.
This amendment would enable two or more joint consultative committees to set up a joint sub-committee.

Amendment agreed to.

Amendment made: No. 23, in page 13, line 26, after 'and' insert 'provide'.—[Mr. Alison.]

Clause 11

SUPPLY OF GOODS AND SERVICES BY SECRETARY OF STATE

Amendment made: No. 24, in page 14, line 33, after '(3)(b)', insert 'or (c)'.—[Mr. Alison.]

Mr. Alison: I beg to move, Amendment No. 25, in page 15, line 9, at end insert:
'(6A) The Secretary of State may by order provide that, in relation to a vehicle which is made available by him in pursuance of this section and is used in accordance with the terms on which it is so made available, the Vehicles (Excise) Act 1971 and Part VI of the Road Traffic Act 1972 shall have effect with such modifications as are specified in the order.'.

Mr. Deputy Speaker: With this amendment can also be discussed:
Amendment No. 101, in Schedule 4, page 91, line 21, at end insert:

'133A. In section 22 of the National Health Service (Scotland) Act 1972 (supply of goods and services to local authorities, etc), after subsection (2) there shall be added the following subsection:—
(3) The Secretary of State may by order provide that, in relation to a vehicle which is made available by him in pursuance of this section and is used in accordance with the terms on which it is so available, the Vehicles (Excise) Act 1971 and Part VI of the Road Traffic Act 1972 shall have effect with such modifications as are specified in the order.".
133B. In section 23 of that Act (assistance to voluntary organisations), after subsection (1) there shall be added the following subsection:—
(1A) The Secretary of State may by order provide that, in relation to a vehicle which is made available by him in pursuance of this section and is used in accordance with the terms on which it is so available, the Vehicles (Excise) Act 1971 and Part VI of the Road Traffic Act 1972 shall have effect with such modifications as are specified in the order.".
133C. In section 34(2) of that Act (transfer of other staff), after paragraph (f) there shall be inserted the following paragraph:—
(g) an education authority wholly or mainly as a speech therapist for the purposes of providing special education in pursuance of sections 1 and 3A of the Education (Scotland) Act 1962."'.
No. 102, in page 91, line 22, leave out 'the National Health Service (Scotland) Act 1972' and insert 'that Act'.

Mr. Alison: These amendments give power by order to modify the enactments dealing with the licensing and insurance of vehicles where the use of National Health Service vehicles is made available under Clause 11 to local authorities. Amendment No. 27 to Clause 13 makes similar provision in respect of vehicles the use of which is made available under Clause 13 to voluntary bodies. Amendment No. 101 makes comparable provision for Scotland.

Amendment agreed to.

Clause 12

SUPPLY OF GOODS AND SERVICES BY LOCAL AUTHORITIES

Dr. Stuttaford: I beg to move Amendment No. 26, in page 15, line 34, at end insert:
'and the local authority shall establish a special committee of the authority, not being the committee established under section 2 of the Local Authority Social Services Act 1970.


to administer the said services and to employ the necessary persons'.
This amendment is proposed at the request of the medical profession and the nursing profession—indeed, everyone involved in medicine other than administrators. Ever since 1970 when Seebohm divided the medical service people away from one another there has been anxiety about the liaison between doctors and social workers. More recently this anxiety has become much more pronounced. It has involved not only social workers working outside the health service but medical social workers within hospitals and psychiatric social workers.
There has been increasing anxiety because these people who are in the hospital service are in many ways almost the elite of the social worker service. They are people who have had long training, and many have a degree, and for many years they have been part of the medical and surgical teams within the hospitals. No ward round is ever complete unless we have had the opinion of the almoner. She not only helps the patients in hospital but follows them up after they leave. The psychiatric social worker is a link—it is a woman—between the hospital and general practitioners. She is a woman of influence—enormous influence, not only with doctors but the patients and their families.
These are people who have been largely neglected and deserted. We learned with horror that they are paid less than other social workers, and their terms of service are less good. The Council of the British Medical Association has been anxious for an amendment so that these workers should remain part of the National Health Service, and should not, at any rate without some safeguards, be transferred to local authorities. So there has been put forward this idea that there should be this committee.
The explanation of how it will work is better than anything I could dream up:
The council—
of the British Medical Association—
'urges that the NHS Reorganisation Act should require every local authority to establish a special committee to administer the social services for the area health authority. The latter should be strongly represented, by right, on this committee, and the social workers concerned with the NHS should be employed by the special committee, not by the local authority: in much the same way as con-

tractors are to be in contract with the family practitioner committee, not with the area health authority.
In this way it is hoped that there will be close liaison between doctors and social workers, that the social workers working within hospitals will be integrated as they are today into a medical or surgical team as well as into the work outside and that the divergence between social and medical work will cease.
That divergence is entirely artificial. The social problems of the patient are every bit as important as are the medical problems; the two cannot be divided. One cannot say where the doctor's province ends and the social worker's begins. We are dealing with the patient in the round, his physical and mental condition, whether he is diseased or healthy, his background and his family. These divisions cannot be made. They should never have been countenanced in 1970 and we want this retrograde step to be taken no further.

Sir K. Joseph: My hon. Friend the Member for Norwich, South (Dr. Stuttaford) does not have to persuade me. I understand the concern of the medical profession and I share its view that there should be the minimum possible division between the social workers and the medical, nursing and other workers. I quarrel only with the particular proposal embodied in the amendment and the need for it.
With the best intentions, the effect of the amendment would be to create a further division. Instead of the health world on the one hand and the social service world on the other, the social service world would be divided into two, with the director of social services employing the staff serving two committees possibly giving conflicting instructions.
I will not spend time describing the damage that will be caused because I want to comfort my hon. Friend with the proposals contained in the Bill and those which will be covered later by regulation. There will be in every area health authority and every local authority joint consultative committees on which the area health authority and the local authority will place members. Those joint committees will be designed to see that the health, social and other local authority services do their planning and implement


their services together. The authorities will be required to produce statutory reports through which any failure to agree on joint plans and implementation will be ventilated to the public and the Minister.
As for the social services within the health service, my hon. Friend and the House will be aware that social workers will be transferred to the local authorities, subject to a number of safeguards. The safeguards are now being worked on in detail by a joint working party which consists of representatives from local authorities and health authorities and includes social workers.
The safeguards will include a requirement that no health service social worker in post on the eve of 1st April 1974 will be required to leave work as a social worker in the health service without his or her specific agreement. The safeguards will include a requirement on the local authorities to staff the health service with the social workers required.
The directors of social services are enthusiastic to improve the social work services in the health service. I assure my hon. Friend that the safeguards and provisions in the Bill and those that will emerge from the working party and be embodied in regulations achieve the purpose that he and the Government share much better than does the amendment. I entirely understand the object of the amendment and sympathise with it but its effect would be damaging.
I hope that my hon. Friend will withdraw the amendment and communicate to the British Medical Association the assurance which I have given.

Mr. Pavitt: May I say that this is about the only part of the right hon. Gentleman's Bill on which I can say that I am in entire agreement with him?

Dr. Stuttaford: I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 13

VOLUNTARY ORGANISATIONS AND OTHER BODIES

Amemndment made: No. 27, in page 16, line 19, at end insert:

'; and subsection (6A) of section 11 of this Act shall have effect in relation to a vehicle made available in pursuance of this section as if for the reference to that section there were substituted a reference to this section'.—[Mr. Alison.]

Clause 16

TRANSFERS FROM LOCAL AUTHORITIES

Amendment made: No. 28, in page 21. line 17, leave out from 'authority' to end of line 19.—[Mr. Alison.]

Clause 18

TRANSFERS TO EMPLOYMENT BY NEW AUTHORITIES AND SOCIAL SERVICE AUTHORITIES

Amendment made: No. 29, in page 22, line 10, leave out from authorities ' to ' or ' in line 13.—[Mr. Alison.]

Clause 19

PROVISIONS SUPPLEMENTARY TO S. 18

Mr. Pavitt: I beg to move Amendment No. 124, in page 25, line 41, leave out ' taken as a whole'.
I understand that it will also be convenient to take with this amendment, Amendment No. 125, in page 26, line 9, leave out 'taken as a whole' and Amendment No. 126, in page 26, line 17, leave out 'taken as a whole'.
Clause 18 deals with many matters relating to the transfer of staff from one place to another. Clause 19, which the amendment seeks to adjust, tries to give the maximum amount of promotion to the staff who are transferred.
One of the major areas of concern relates to the decision by the Government to make a comprehensive service by bringing school health into the National Health Service. This will mean a considerable amount of transfer from the local authorities to the new set-up involving area health authorities, and so on. The amendment seeks to strengthen the safeguards which are already contained in the clause. If the words referred to in the amendment are left in, there will remain a number of technical problems in terms of the staff so transferred.
The other terms involved include hours of work, overtime arrangements, arrangements for sick leave, special leave, disciplinary codes and so on. One vexed question which takes officers a long time to work out is the preparation of travel allowance and subsistence sheets. Staff who have managed to master the system in one area find that it completely changes when they move to another area where the rules and regulations are somewhat different. This also applies to the period of notice required if a person wishes to change his service. If the provision is left as it stands, instead of protection being given to those who are transferred they may find themselves worse off.
I looked into the situation of officers in the Inner London Education Authority who will be affected by the transfer and I found a disparity between the different grades. Some grades will be better off; some will be worse off. Since the Under-Secretary of State has said many times in the past that he favours uniformity throughout the service, it would be most helpful if there could be uniformity of the arrangements relating to transfer between the departments. The new departure, as the Clause stands, gives less protection to local government officers than they have at present under the London Government Act 1963, on the Committee on which I had the pleasure of serving with the Secretary of State, then holding another office.
2.45 a.m.
If, after the date of transfer, a change of conditions happens to be proposed, it may be necessary, as the clause stands, to have special negotiations and arbitration to compensate for deterioration.
So, to my four words, I have added a few more, in the hope of persuading the Under-Secretary that such a little amendment, so amiable and helpful to the staff he is anxious to keep sweet-tempered when he transfers them from one authority to the new authority, should be accepted.

Mr. Alison: I hope that the hon. Gentleman will not think it presumptuous of me, even at this late hour, to congratulate him on speaking from the Front Bench on his own favoured and cherished subject of the National Health Service. I am sorry that he should have done so in moving an amendment to which I cannot

respond in the way I should have wished to on this memorable, almost birthday, occasion.
I am advised that the effect of these amendments would be to introduce into the concept of protection of terms and conditions of services, other than remuneration, a wholly undesirable degree of inflexibility, in that it would not be open to employing authorities to adversely modify any single one of these terms and conditions no matter how slight the modification or how great the improvement offered in some other associated condition.
The phrase "taken as a whole" was used in the National Health Service (Scotland) Act 1972 and was accepted by the House then. It is particularly appropriate in the context of National Health Service reorganisation, as a result of which the new health authorities will have in their employ not only staff who have till now been employed on NHS terms and conditions but also staff from local authorities where the terms and conditions of employment may well have varied greatly in detail both from the NHS and from other local authorities.
The ability to modify terms and conditions of service within the overall degree of statutory protection proposed by the Bill will be a valuable aid to the assimilation into the new service of staff from these different backgrounds which the hon. Gentleman and others are seeking. In some cases, some adjustment may be necessary if the job is to be done properly. There would be cases, for example, where the terms and conditions of existing employment specified the actual hours of attendance, and it would be undesirable that a condition of this sort should be inflexibly preserved without regard to the interests of the service as a whole and of the patients it serves.
There is no intention of attempting any general worsening of conditions of service; nor is it intended to attempt to offset any individual condition of service that is more favourable against quite unrelated and less favourable condition of service. In any case in which staff feel that the provisions of the Bill have not been followed, they will be able to appeal against action which they believe worsens their terms and conditions of employment.
The Bill affords a high degree of protection and, taken with the provisions for the determination of questions arising, seem adequately to recognise the interests of individuals. The phrase "taken as a whole" merely recognises the possible need for a degree of flexibility in the assimilation of staff from many different sources and, in spite of the uniqueness of the occasion on which the amendment was moved, I must ask the House to reject it.

Amendment negatived.

Amendments made: No. 30, in page 26, line 28, after '(4)', insert '(a)'.

No. 31, in line 32, leave out 'except subsection (4)'.—[Mr. Alison.]

Clause 25

TRANSFER OF TRUST PROPERTY HELD FOR HEALTH SERVICES BY LOCAL HEALTH AUTHORITIES.

Amendment made: No. 32, in page 31, line 34, leave out subsection (4).—[Mr. Alison.]

Clause 34

MATTERS SUBJECT TO INVESTIGATION

Mr. John: I beg to move Amendment No. 34, in page 37, line 24, leave out subsection (4) and insert:
(4) A Commissioner shall conduct an investigation under this Part of this Act unless he is satisfied that it is unreasonable so to do because of the availability of other remedies and the ability of the aggrieved person to avail himself of such remedies; and for the purpose of this subsection, "other remedies" shall mean a course of action in a court of law which is still available to the aggrieved person and which directly covers his grievance.
The amendment deals with matters subject to investigation by the Health Service Commissioner.
One of the most difficult features of the Bill, which the right hon. Gentleman has also found, has been the inclusion and exclusion of matters subject to investigation by the commissioner. As the Bill is drafted, the commissioner shall not conduct an investigation in respect of any action in respect of which the person aggrieved has or had a right of appeal or right of reference to a tribunal or any

action in which the person aggrieved has or had a remedy by way of proceedings in a court of law.
It is true that the last sentence of the subsection says the commissioner may conduct an investigation if he is satisfied that in the circumstances the person would not reasonably have resorted or would resort to the remedy. However; in my view, the amendment makes the provision a better one both in its language and in its emphasis. It places a duty on the commissioner to investigate a complaint unless he is satisfied that it is unreasonable to do so by reason of the availability of a remedy. It emphasises the need for the commissioner to investigate as many cases as possible and to rule out only those cases where because of the availability of other remedies and the ability of the aggrieved person to avail himself of such remedies it would be unreasonable for him to conduct such an investigation.
This, together with the definition, forms the basis of the amendment. Other remedies shall mean a course of action in a court of law which is still available to the aggrieved person and which covers his grievance directly.
Two points emerged from the debate in Committee. First, the use of the words "has or had" means not only an action or right of appeal which is currently available to the person but which had been available at one time but which had now either become statute barred or barred by reason of the effluxion of time. Although the commissioner has a discretion to investigate that, I do not think that that is good enough. I believe that if a remedy is to debar a person from having an investigation, it should be a current and relevant remedy at that stage. It should be a remedy that he can enforce then. The wording of the amendment would cover that.
The second point to emerge covered a number of ancillary matters. In this regard, I thank the right hon. Gentleman for his letter in answer to certain of them concerning matters which could form an ancillary basis of a remedy without touching on the main part of the question. But I do not think that the right hon. Gentleman's letter fully meets the point. The question which I posed was whether an investigation into a matter by the


commissioner would be precluded by reason of the fact that there would be a libel in it.
The right hon. Gentleman said that the commissioner could investigate the remedy part without investigating the libel, but often the two are so intertwined that it would be impossible to look into one without looking into the other. Acceptance of the amendment would considerably help to rectify the position. Therefore, on the ground of both elegance of style and effectiveness of the power given to the commissioner, I ask the Secretary of State to accept the amendment.

Mr. Pavitt: This amendment is part of a whole series of attempts by the Opposition to widen the scope of the Health Service Commissioner, so I hope that it will be accepted. Reading the proceedings in Committee on this clause, it is obvious that we accept the commissioner's power in its present form, but we shall eventually hope to widen its scope in many ways.

Sir K. Joseph: I am not really equipped to argue theological niceties with the hon. Member for Pontypridd (Mr. John). I have the feeling that if all his amendments had been incorporated into the Bill he would have found admirable reasons for objecting to them and substituting those parts of the Bill which he is now criticising. I do not mean that in any malicious way.
I think that in attempting to define the powers of the commissioner we are trying to define the indefinable. There will be so many variants of the circumstances that I rest solidly upon the discretion that the Government propose, which is embodied in the Bill.
The amendment to which the hon. Gentleman has spoken, as always so effectively, supported by his hon. Friend the Member for Willesden, West (Mr. Pavitt), would conflict with the discretion given to the Health Service Commissioner in Clause 34(7) to determine whether to initiate investigations. The amendment would compel him to investigate complaints that were not duly made, that offended the requirement in, for example, Clause 35(4), that were made out of time or had not first been referred to the responsible health authority. It would

also exclude cases where the complainant clearly still had open to him a legal remedy.
I am sure that the hon. Gentleman is right in postulating circumstances where we would all expect the commissioner, despite the provisos, to exercise his jurisdiction. But the Government rest solidly for those circumstances on the discretion that is central to the Bill.
Therefore, not because I think the hon. Gentleman is not right in suggesting that there will be difficult circumstances, but because I believe that even he would not be able to define and encapsulate them all, I hope that the House will accept the discretion and that the hon. Gentleman will not press his amendment.

Amendment negatived.

Clause 47

EXPENSES OF NEW HEALTH AUTHORITIES

Amendment made: No. 35, in page 47, line 26, leave out paragraph (d).—[Mr. Alison.]

Clause 55

INTERPRETATION ETC.

Amendment made: No. 36, in page 51, line 30, at end insert
'and a body exercising delegated functions of such an authority in pursuance of section 46 of the Local Government Act 1958'.—[Mr. Alison.]

Clause 58

CITATION, COMMENCEMENT AND EXTENT

Amendments made: No. 39, in page 54, line 19, leave out '(2) This Act' and insert:
'(2) The following provisions of this Act shall come into force on the passing of this Act, namely sections 1, 5 to 10, 14 to 21, 23 to 26, 29, 30, 41 (so far as it is applied by section 16 and 18), 44, 47 to 49, 51 to 57 and this section, Schedules 1 and 2, paragraphs 22, 77, 129, 134, 141 and 142 of Schedule 4 and the entry in Schedule 5 relating to section 36(3)(c) of the principal Act.
(2A) The provisions of this Act which do not come into force in pursuance of the preceding subsection'.

No. 40, in page 54, line 31, leave out 'subsection (1)' and insert 'subsections (1) to (2A)'.

No. 41, in page 54, line 32, leave out '50 and 51' and insert:
', section 39(1) so far as it relates to those sections, sections 50, 51 and 57'.

No. 42, in page 54, line 33, after '43', insert '49'.

No. 135, in page 54, line 33, leave out from first 'to' to end of line and insert:
`80, 94, 100, 101, 103, 105, 119, 124, 126, 129 to 131 and 133A to 140C,'.

No. 44, in page 54, line 35, after '1947', insert 'the Dentists Act 1957,'.

No. 45, in page 54, line 35, after '1958', insert 'the Radioactive Substances Act 1960,'.

No. 46, in page 54, line 36, after '1962', insert:
'the Redundancy Payments Act 1965 (excluding the reference to paragraph 6),'.

No. 47, in page 54, line 38, after '1972', insert 'and'.

No. 137, in page 54, line 38, leave out 'section 50' and insert:
'subsection (2A) of this section, sections 32(6) and 50 and paragraphs 133A and 133B of Schedule 4'.

No. 49, in page 54, leave out lines 39 to 42.

No. 50, in page 55, line 2, leave out 'subsection (1)' and insert 'subsections (1) to (2A)'.

No. 51, in page 55, line 3, leave out from '37(5)' to end of clause and insert:
'section 39(1) so far as it relates to those sections, section 57, paragraphs 40, 67, 77 to 80, 94, 100, 101, 105, 124, 126, 130, 139 and 140A of Schedule 4 and the entries in Schedule 5 relating to the Polish Resettlement Act 1947, the Dentists Act 1957, the Opticians Act 1958, the Radioactive Substances Act 1960, the Health Visiting and Social Work (Training) Act 1962 and the Order in Council of 1972'.—[Mr. Alison.]

Schedule 1

ADDITIONAL PROVISIONS RELATING TO NEW AUTHORITIES

Amendments made: No. 56, in page 57, line 24, leave out 'that' and insert 'the relevant Regional'.

No. 57, in page 57, line 25, after 'bodies', insert:
'(including any federation of workers' organisations)'.

No. 58, in page 61, line 24, after first 'regulations', insert:

'and such directions as may be given by the Secretary of State'.

No. 59, in page 61, line 29, after 'functions' insert:
'of the authority or any other body'.

No. 60, in page 61, line 34, after 'another' insert:
'which is not a Family Practitioner Committee'.—[Mr. Alison.]

Dr. Summerskill: I beg to move Amendment No. 61, in page 62, line 10, at end insert
'but such regulations shall not preclude an authority and consultants from agreeing by contract to such whole-time employment'.
This is a question of emphasis and clarification. As it stands paragraph 5 does not require that consultants shall be whole time, but I think it desirable to provide that this does not mean that they cannot agree to be whole time. The emphasis at the moment is on almost encouraging them not to be whole time. In a Bill of this importance, consultants should be encouraged to be whole time. It is regrettable that only a third of all consultants in the Health Service at the moment practice full time, and we would wish to see far more in full-time practice.
The next Labour Government will be phasing out pay beds so that there will be no scope for private practice within hospitals. It is right, therefore, that something should be in the Bill to encourage consultants to take up full-time work.

Mr. Pavitt: I support my hon. Friend. The encouragement of which she spoke may receive a little impetus from the decision of the British Medical Association last week to do away with the secrecy which at the moment attaches to merit awards. The Amendment envisages the possibility of agreement being reached between the consultants and the employing authority for a whole different system of whole-time consultant employment.
If merit awards were attached more to full-time and less to part-time, nine-elevenths consultants, there would be a wide area in which agreement could be reached. After 25 years of accepting this business whereby one consultant gets twice as much as another and no-one knows which is which, the Amendment would facilitate further agreement.

Mr. Alison: The hon. Member for Willesden, West (Mr. Pavitt) is popping up in all sorts of different parts of the Chamber. It is bewildering. His point goes wider than the subject of the speech of his hon. Friend the Member for Halifax (Dr. Summerskill).
Subparagraph (5) of paragraph 10—which the hon. Lady has sought to amend—does not prevent or discourage the employment of whole-time consultants. It does no more than carry forward into the new Bill the statutory safeguard provided by Mr. Aneurin Bevin in the context of the first post-war Labour Government against the introduction of a compulsory full-time service universally by regulation and by regulation alone. In other words, it means that legislation must be brought forward if there is to be a universal whole-time consultant service in the National Health Service.
It has been the policy of successive Governments since 1948, and remains the policy of the present Government, that, subject to the needs of the service, employing authorities should be able to offer the option of a whole-time or maximum part-time contract to a practitioner selected for a full-time consultant post. However, hospital authorities also have the right to advertise a whole-time post without giving the applicant the option of maximum part-time employment when the authority considers that the interests of the service requires it. In fact, at the moment not one-third but as much as 36·5 per cent. of all consultants are whole time, and the proportion has been rising in recent years. It is certainly not the intention of the present Government to discourage the appointment of consultants with a full sessional commitment, and it is hard to imagine that there would ever be any advantage in so doing. The amendment would provide a safeguard against something that is unlikely to occur.
The House can see from the evidence that I have given that the Government have happily gone along with the growing practice of appointment by regions of whole-time posts. There is no need for the amendment. I can assure the hon. Lady that the anxiety she has that regional boards and health authorities should have the real option to do what they want is safeguarded in the Bill. I

therefore suggest that the House rejects the amendment.

Amendment negatived.

Schedule 4

MINOR AND CONSEQUENTIAL AMENDMENTS OF ENACTMENTS

Amendments made: No. 62, in page 64, leave out line 32 and insert:
' "excluding Part VI except section 198." '

No. 136, in page 69, line 42, leave out from Council ' to end of line 43 and insert:
'of which the district includes any part of the Authority's area'.

No. 63, in page 72, line 35, leave out from '1973' to end of paragraph.

No. 64, in page 73, line 9, leave out from 'Wales' to end of line 10 and insert:
', of a special health authority or of a Health Board," '.

No. 65, in page 74, line 41, leave out '23(2) of the Midwives Act 1951' and insert:
'11 of the Midwives Act 1951 (which prohibits unqualified persons from acting for gain as maternity nurses in any area on and after the date on which that section is applied to the area by an order under subsection (2) of that section), subsection (2) and the words from "on or after" to "therein" in subsection (1) shall cease to have effect.
60A. In section 23(2) of that Act'.

No. 66, in page 74, line 47, at end insert:
'60B. Sections 26 and 27 of that Act (which authorise a local supervising authority to aid the training of midwives and to provide residential accommodation for pupil midwives) shall cease to have effect'.

No. 67, in page 75, line 32, leave out from 'words' to end of line 36 and insert:
'from "Regional" to "Council" there shall be substituted the words "Regional" Health Authority, Area Health Authority or Family Practitioner Committee

No. 68, in page 76, line 28, leave out 'such a health centre as is referred to' and insert:
'a health centre provided as mentioned'.

No. 69, in page 77, line 10, leave out from first 'the' to 'and' in line 12 and insert:
'words from "approved" to "for the area" there shall be substituted the words "approved" by a regional nurse—training committee"'

No. 70, in page 77, line 42, at end insert:
'of attending persons in their homes" '

No. 71, in page 78, line 5, leave out 'paragraph 1 (f)' and insert:
'sub-paragraph (f) of paragraph 1'.

No. 72, in page 78, line 6, leave out 'paragraph' and insert 'sub-paragraph'.

No. 73, in page 78, line 12, leave out paragraph 1(g)' and insert:
'sub-paragraph (g) of paragraph 1'

No. 74, in page 78, line 13, leave out 'paragraph' and insert 'sub-paragraph'.

No. 75, in page 79, line 12, leave out from 'for' to end of line 34 and insert:
'paragraphs (a) to (d) there shall be substituted the words "of services under section 2 or 3 of the National Health Service Reorganisation Act 1973 or section 2, 5 or 6 of the National Health Service (Scotland) Act 1972 or Article 5, 8, or 9 of the Health and Personal Social Services (Northern Ireland) Order 1972 and services at health centres provided under the said section 2 or Article 5" '.

No. 76, in page 80, line 9, leave out from 'Health)' to end of paragraph and insert:
'before the words "Welsh Board of Health" there shall be inserted the words—
records of property passing to Regional or Area Health Authorities or special health authorities under sections 23 and 26 of the National Health Service Reorganisation Act 1973,
records of property held by a Regional or Area Health Authority or special health authority under section 21 and 22 of the said Act of 1973" '.

No. 77, in page 81, line 33, after 'local', insert 'health'.

No. 78, in page 83, line 24, at end insert:
', and in this sub-paragraph "local authorities" means authorities established by or under the Local Government Act 1972 or the London Government Act 1963.'.

No. 79, in page 83, line 35, leave out:
'British Medical Association and the'.

No. 80, in page 83, line 37, leave out 'medical practitioners' and insert:
'specialists in community medicine'.

No. 81, in page 83, line 37, at end insert:

'The London Government Act 1963

100A. Subsections (1) to (6) of section 32 of the London Government Act 1963 (which relate to the co-ordination of school and other health services in inner London) shall cease to have effect.'.

No. 82, in page 84, line 10, leave out 'or special health authority' and insert:
',special health authority, Health Board or the Common Services Agency for the Scottish Health Service'.

No. 83, in page 84, line 20, at end insert:

'The General Rate Act 1967

104A. In section 45 of the General Rate Act 1967 (which provides for relief from rates in respect of facilities for disabled persons), for the words "local health authority" in paragraph (b) there shall be substituted the words "local social services authority".'.

No. 84, in page 84, line 26, after 'Committee', insert 'or Board of Management'.

No. 85, in page 84, line 29, at end insert:
', a Health Board or the Common Services Agency for the Scottish Health Service'.

No. 86, in page 84, line 35, leave out from ' and ' to end of line 39 and insert:
'in paragraph (b) for the words "Act of 1946" there shall be substituted the words "Acts of 1946 to 1973" '.

No. 87, in page 87, line 41, leave out from 'section' to end of line 15 on page 88 and insert:
'at the end a the definition of "the relevant enactments" there shall be inserted the words "and the National Health Service Reorganisation Act 1973" '.

No. 88, in page 88, line 18, leave out from 'organisations' to end of line 21 and insert:
'at the end of subsection (3)(a) there shall be inserted the words "the National Health Service Reorganisation Act 1973"'.

No. 89, in page 88, line 29, leave out from 'organisations' to end of line 32 and insert:
'at the end of subsection (3)(b) there shall be inserted the words "the National Health Service Reorganisation Act 1973" '.

No. 90, in page 89, line 2, leave out from 'words' to end of line 4 and insert:
'from "a local health authority" onwards there shall be substituted the words "the Secretary of State or the Ministry of Health and Social Services for Northern Ireland".'.

No. 91, in page 89, line 9, at end insert:
'and for the words "Health Services Acts (Northern Ireland) 1948 to 1967" there shall be substituted the words "Health and Personal Social Services (Northern Ireland) Order 1972".'.

No. 92, in page 89, line 13, at end insert:
'and for the words "section 17 of the Health Services Act (Northern Ireland) 1948" there shall be substituted the words "Article 5 of the Health and Personal Social Services (Northern Ireland) Order 1972".'.

No. 93, in page 89, line 25, at end insert:
`and in paragraph (c) of that definition for the words from "means" onwards there shall be substituted the words "means a Health and Social Services Board, the Northern Ireland Central Services Agency for the Health and Social Services or the Northern Ireland Staffs Council for the Health and Social Services established under the Health and Personal Social Services (Northern Ireland) Order 1972".'.

No. 94, in page 90, line 20, at end insert:
`or section 34A of the National Health Service (Scotland) Act 1972'.

No. 95, in page 90, line 38, leave out 'word "1946" ' and insert words "1946 or" '.

No. 96, in page 90, line 39, leave out from 'words' to end of line 40 and insert '"by a Health Board"'.

No. 97, in page 90, leave out line 43 and insert:
', Family Practitioner Committee or Health Board" '

No. 98, in page 91, line 3, after 'Authority' insert 'or special health authority'.

No. 99, in page 91, line 4, at end insert:
`or to the Secretary of State if no such authority is so responsible'.

No. 100, in page 91, line 5, leave out sub-paragraph (2) and insert:
'(2) Paragraphs (b) and (c) of subsection (1) of that section shall be omitted '.

No. 101, in page 91, line 21, at end insert:
'133A. In section 22 of the National Health Service (Scotland) Act 1972 (supply of goods and services to local authorities, etc.), after subsection (2) there shall be added the following subsection:
(3) The Secretary of State may by order provide that, in relation to a vehicle which is made available by him in pursuance of this section and is used in accordance with the terms on which it is so available, the Vehicles (Excise) Act 1971 and Part VI of the Road Traffic Act 1972 shall have effect with such modifications as are specified in the order.".

133B. In section 23 of that Act (assistance to voluntary organisations), after subsection (1) there shall be added the following subsection:
(1A) The Secretary of State may by order provide that, in relation to a vehicle which is made available by him in pursuance of this section and is used in accordance with the terms on which it is so available, the Vehicles (Excise) Act 1971 and Part VI of the Road Traffic Act 1972 shall have effect with such modifications as are specified in the order.".
133C. In section 34(2) of that Act (transfer of other staff), after paragraph (f) there shall be inserted the following paragraph:
(g) an education authority wholly or mainly as a speech therapist for the purposes of providing special education in pursuance of sections 1 and 3A of the Education (Scotland) Act 1962."'.

No. 102, in page 91, line 22, leave out 'the National Health Service (Scotland) Act 1972' and insert 'that Act'.

No. 103, in page 91, line 39, leave out first 'the'.

No. 104, in page 94, line 4, leave out 'Northern Ireland' and insert 'Wales'.

No. 105, in page 94, line 5, after '48(5)' insert:
',50(1), paragraphs 104, 128, 130, 143 to 145 and 152 of Schedule 6, Schedule 7 so far as it relates to paragraphs 3 and 5 of Schedule 3 to the Redundancy Payments Act 1965'.

No. 106, in page 94, line 6, at end insert:
'140A. After section 65(3) of that Act there shall be inserted the following subsection:
(4) The following provisions of this Act shall extend to Northern Ireland, namely, this subsection, sections 42(4), 47, 48(5), 50(1), paragraphs 104, 128, 130, 143 to 145 and 152 of Schedule 6 and subsection (1) of this section so far as it relates to the other provisions mentioned in this subsection.
140B. In Schedule 6 to that Act (minor and consequential amendments to enactments), after paragraph 20 there shall be inserted the following paragraph:
20A. In section 18(5) (application to Scotland of provisions in respect of superannuation of officers of certain hospitals), at the end there shall be added the words ", for the reference to Regional Hospital Boards or Area Health Authorities of a reference to Health Boards and for the reference to services under the National Health Service Acts 1946 to 1973 of a reference to services under the National Health Service (Scotland) Acts 1947 to 1973".
140C. In Schedule 6 to that Act (minor and consequential amendments to enactments), after paragraph 156 there shall be inserted the following paragraph:

The Road Traffic Act 1972

156A.—(1) In section 156(1)(c) of the Road Traffic Act 1972 (which provides that payment


for hospital treatment of a traffic casualty will be made payable to the Secretary of State or to a Regional Hospital Board or Board of Management), for the words from "Regional" to "Management" there shall be substituted the words "Health Board".'—[Mr. Alison.]

Schedule 5

REPEALS

Amendments made: No. 107, in page 95, column 3, leave out lines 46 to 49.

No. 108, in page 96, line 38, column 3, leave out 'entry relating to the' and insert 'definition of'.

No. 109, in page 96, line 55, column 3, at end insert:
'except so much of the entry relating to section 244 of that Act as ends with the word "Minister")'.

No. 110, in page 97, column, 3, leave out lines 8 to 11 and insert 'Section 47 (10)'.

No. 111, in page 97, line 12, column 3, leave out '9(2)' and insert '6(3)'.

No. 112, in page 97, column 3, leave out line 13 and insert:
'In Schedule 3, the entry relating to the National Health Service Act 1946.'.

No. 113, in page 98, leave out lines 8 to 11.

No. 114, in page 99, line 2, column 3, at beginning insert:
'Section 32(1) to (6)'.

No. 115, in page 99, column 3, leave out lines 50 to 55.

No. 116, in page 100, line 17, column 3, at end insert:
'and the words from "section 4" to "1967".
In section 64(3)(a), the words "the National Health Service (Family Planning) Act 1967" '

No. 117, in page 100, line 18, column 3, after '65' insert 'in subsection'.

No. 118, in page 100, line 20, column 3, at end insert:
'and in subsection (3)(b) the words "the National Health Service (Family Planning) Act 1967" '

No. 119, in page 101, line 2, column 3, at end insert 'and (c)'.

No. 120, in page 101, column 3, leave out line 9 and insert:
' , 98 to 100, in paragraph 130 the words from "for paragraph 1" to "and", and paragraphs 103, 131, 133, 142 and 153.'.

No. 121, in page 101, line 21, column 3, leave out 'and 23' and insert:
23, 78, 79 and 80'.

—[Mr. Alison.]

Bill to be read the Third time this day.

ADJOURNMENT

Motion made, and Question proposed, That this House do now adjourn.—[Mr. John Stradling Thomas.]

NEWPORT TUBE WORKS (CLOSURE)

3.10 a.m.

Mr Roy Hughes: Even at this hour I welcome the opportunity to raise the question of the decision to close the Newport Tube Works. If this decision goes ahead it will be a severe blow to the economy of the town of Newport and all the surrounding districts.
I understand that further discussions took place yesterday between top officials of the British Steel Corporation and the Steel Committee of the TUC. Whatever the outcome of those discussions might have been, this situation cannot be considered in a vacuum. There are serious social implications, for if this works closes 1,100 male job opportunities will be gone for ever, despite whatever palliatives may be offered to the workpeople concerned by way of jobs in other works, early retirement, and so on.
I have no intention of standing aside in this situation. This works has been established in Newport for well over half a century. It occupies an excellent site of well over 100 acres, only one-third of which is used. It has a very good geographical location, closely linked to the two principle motorway networks to the South-East and the Midlands and near to thriving docks and a main line railway centre.
The quality of the product of the works is known the world over, as many customers have testified in recent months. The works has always enjoyed good industrial relations.
According to the original announcement, the British Steel Corporation's decision was based on the pure arithmetic of market forecasts. The tubes group of the corporation is apparently capable of producing 370,000 tons annually. The market forecasts at the time indicated a requirement of 300,000 tons. The Newport works is capable of producing 70,000 tons. Therefore, the BSC reasons that if the Newport works was closed the figures would balance. But this is purely the computer and the bureaucratic mind at work. We must ask ourselves how these figures work out in practice.
I understand that on 27th April a memorandum was issued by the corporation indicating that there was at that time a 26-week to 32-week delivery date for tubes of between 6⅝ in. and 18 in.
Is it any wonder that the IMEG Report—"Study of potential benefits to British industry from offshore oil and gas developments"—states, at the top of page 54:
Adverse comments concerning the ability of BSC to supply steels competitively, on time, etc., were a common feature of our interviews with equipment suppliers.
The findings of this independent inquiry make it even more difficult to understand the reasons for the corporation's decision to close the Newport works. The original decision was taken when the economy was in a depressed state, but it is unrealistic to impose an output ceiling in the present situation, because flexibility is needed to meet the fluctuation in world and home demand.
Since the decision was taken we have had the floating of the pound, which gives the British Steel Corporation a price advantage which will remain as a result of the flotation even when our steel prices are raised to European Economic Community levels. It is unrealistic to talk of a closure when we have such a price advantage.
A further major factor is that of the Celtic Sea possibilities. It is reckoned that by the end of the summer there will be no fewer than six rigs drilling in the area. Is this the time to close the best oil well casing producer in the United Kingdom?
Dr. David Whitbread, director of a specialist firm of exploration consultants, is quoted in the Daily Express on 10th

March as having said this of the Celtic Sea possibilities:
I am trying to control my optimism, but my firm belief is that this whole area will be one of the exploration hot spots over the next five years.
The closure decision following the IMEG report could be almost said to be against Government policy, because the Department of Trade and Industry has said that it would follow policies to ensure that United Kingdom industry got a much greater share of the oil prospecting development orders than hitherto.
The IMEG report states, at the bottom of page 13:
The BSC should be strongly urged to establish the present and future requirements of the offshore oil and gas industry as one of its principal targets in respect of both investment and research and development effort.
Investment, not closure, is what the Newport works require.
There is the position of Mr. J. P. Gibson, who has been appointed head of the Offshore Supplies Office of the Department of Trade and Industry. I understand that his function is to advise and direct British firms whose products would be channelled into offshore exploration.
Through the Minister, I ask Mr. Gibson if his office will investigate the well casing market to see whether the recommendations set out on page 10 of the IMEG report for increasing British firms' share of the oilfield development from 40 per cent. to 75 per cent. can be implemented if the Newport Tube Works close. Will the Minister tell us about this?
There is also the important question of transport costs. It is reasonable to suggest that the transport charges for bringing pipes to Welsh prospecting areas from Scotland would increase the price by £5 a ton compared with that for locally produced pipes. Will the Under-Secretary give us information about that aspect also?
In order to justify its decision to close the works the BSC indicated that market conditions were bad. That statement must be qualified, however. What is really meant is that the market is increasing rapidly with the increase in oil prospecting and that the corporation expects to supply progressively less and less because of competition on both price and


quality from Japan. Such reasoning does not square with Government policy on the IMEG report.
I have always been an unrepentant believer in public ownership of the British steel industry. We all know of the failure of private owners to invest, expand and modernise. The works at Newport is a typical example. Every penny of profit has been drained out of it and little investment has been put back in. Nevertheless, from a day-to-day study of the activities of the BSC we must conclude that this is not the public ownership that we envisaged.
There are numerous examples of what I mean. One was the statement by Dr. Finniston, chief executive of the corporation on 13th April after he had met an action committee at the works in Newport. He offered 250 jobs in Corby, Northants—an area which, it might be said, could well be in serious difficulty before the decade is out. The most priceless asset Wales possesses is its people, and it is because we have sought to provide work for the people that we have advocated public ownership over the years. The solution to the problem in the 1920s and the 1930s was for the people of Wales to be packed off to Birmingham, Slough, Oxford and other places. They were forced to pull up their roots and whole communities were left derelict. Dr. Finniston needs to be reminded that people like him are not given their £20,000 a year jobs to advocate that sort of solution.
It means too, that a future Labour Government need to look far more closely at the way our nationalised industries are run and the people that we appoint to lead them. Dr. Finniston is also quoted as saying that the question of closure is not only a BSC decision. He said that it was also a local authority and Government responsibility. I challenge the corporation and the Government to keep the works open until Newport is declared a development area and until at least one new factory is located in the town. Or is Dr. Finniston saying that the works requires a subsidy? This works has been highly profitable over a long period, but if it requires a subsidy it is up to the Corporation to ask for one. Surely this works is even more deserving than Lord

Shawcross's BSA. If the BSC is not prepared to act along the lines I suggest, one can only conclude that lost jobs in Newport are of no concern to it.
Whatever the outcome of the situation, the action committee at the works has put up a superb case. Its performance has been exemplary, not least when it presented its case to a Select Committee of the House. In carrying out its task it has been ably backed up by an excellent local trade union official in Mr. John Carberry. Logic and reasonableness have unquestionably been on its side, but these factors may be insufficient in the present situation. Perhaps that is the principal lesson that comes out of the whole episode.

3.26 a.m.

The Under-Secretary of State for Trade and Industry (Mr. Peter Emery): It is of course right for a Minister to come to the Dispatch Box to set out or to explain the Government's policies in relation to our nationalised industries. The steel industry may at times need such an explanation when we are going through a period of rapid change, rapid change that I hope every hon. Member, whatever his local constituency views, would want to support.
The hon. Member will be familiar with the 10-year development strategy in the White Paper. The aim of this strategy is the production of an efficient, modern industry which is able to compete profitably in international markets and which will assure the future employment of its workers.
The modernisation of the industry involves investment in Wales totalling some £900 million over the next 10 years.
However, the corporation cannot concern itself solely with modernisation. One of the responsibilities of management is to ensure that all the available resources, including labour, plant and finance, are utilised to the best advantage. The retention of surplus labour or plant, other than on a purely short-term basis, must reduce the corporation's competitive ability.
Accordingly, if the corporation considers that it has, or because of modernisation will have, over-capacity for a particular product, it must deal with the situation in order to safeguard the


remainder of the industry. This is precisely what the corporation is doing with regard to large seamless tubes, which are the product of the Newport Tube Works.
The corporation's decision to close the Newport works is based on a comparison between the corporation's production capacity, the price of the products and the prospective demand for large seamless tube.
At present there is over-capacity both nationally and internationally for these tubes. The corporation, after careful study, considers that this situation will continue. It has taken into account the demand and the North Sea developments. It has understood the suggestions made by IMEG, but is rightly concerned, as would be any well-managed business, whether nationalised or otherwise, to bring its plant capacity into line with the share of the market which it can reasonably project to meet.
It has accordingly decided that its total capacity must be reduced, and that the most satisfactory solution is to close the Newport works and adopt the modern Clydesdale works in Scotland as the centre of its seamless tubemaking activities. This rationalisation is being supplemented by the replacement of Clydesdale's open-hearth furnaces by electric arc furnaces at a cost of some £9 million. When this modernisation and rationalisation are complete, the corporation judges that it will be well placed to compete profitably in the seamless tube market.
The question has also been raised of the profitability of Newport relative to that of the other tube works. The profitability of an individual works cannot always be taken in isolation, for it is dependent upon many factors, including the product mix and the markets in which the products are sold and the application of central overheads.
Therefore, in this instance, what is much fairer is to make comparisons based on costs, because we want to make a fair comparison. This is what the corporation has done, and in such comparisons it has found that Clydesdale is the lower-cost producer.
I stress that I am only too conscious that the Newport workers derive little consolation from the assured employment prospects at Clydesdale. But it is important that we all understand that,

without these steps, the future employment at all seamless tube works would be imperilled, and not just the employment at Newport.
The Select Committee, in paragraph 47 of its report, recognised that the corporation may from time to time read the market wrongly and that the performance of a plant will not always match its theoretic efficiency. But the Select Committee went on to state that the corporation has the duty to take decisions on job reductions or closures, and that in the Newport case it did so only after consultation with the workers and a careful re-appraisal of the proposals.
I know that the proposed closure has aroused strong local feelings ever since its announcement in January 1972. The hon. Gentleman has sought to persuade the corporation to reverse its decision.

Mr. Roy Hughes: Will the hon. Gentleman tell us something about the quality of the products of the two works, and also something about the profitability of the Clydesdale works?

Mr. Emery: I do not wish to run down what has been done at Newport. I do not think that does anyone any good. The management has decided that Clydesdale is better. Let us just leave it at that.
Following the closure announcement in January last year, the corporation held detailed consultations with the unions, as the hon. Gentleman knows. There have been many consultations as well with Dr. Finniston, Lord Melchett and other senior members of the corporation, who have met the hon. Gentleman and the right hon. Member for Cardiff, West (Mr. George Thomas), and a deputation has been received by my right hon. and learned Friend the Secretary of State for Wales. The works action committee gave evidence before the Select Committee on Nationalised Industries and the hon. Gentleman has raised the matter in the House in Questions and on the Adjournment on 8th May 1972. The matter is, therefore, not new to the House, and has been carefully considered.
The corporation has already delayed the closure by over six months. I am sorry, but I have to say that there is no justification for further delay, nor is there any reason to accede to requests


for further inquiries which would, in my view, only have the effect of delaying the closure.
However, there is a brighter side to Newport's affairs and it would be wrong not to mention it. The closure is not the severe blow to Newport that the hon. Gentleman suggests. In the last thirteen months, the number of unemployed in the Newport travel-to-work area has fallen by almost 40 per cent., and the unemployment rate has fallen from 5·4 per cent to 3·3 per cent.—a figure below that for Wales as a whole. This is an encouraging and proper trend.
There is the continuing major expansion by the BSC of its Llanwern works, which will continue to provide employment for many thousands of steelworkers in Newport in the years to come. In recognition of Newport's problems, the Government have announced the construction of an advance factory and talks are in progress with BSC officials on the possible use of the tube works site for this purpose.
These developments mean that the employment prospects for the men now being declared redundant are far more favourable than when the closure was first announced. The corporation has also made a great contribution towards mitigating the social problems produced by the closure.
Firstly, it postponed the closure by six months. Secondly, the rundown in the labour force has been progressive. The illustration of this is that in January 1972 there were 1,120 employed at the works. By 12th April 1973 this had fallen to 615. By last week it was down to only 450. Thirdly, considerable success has been achieved in providing alternative employment.
About 70 per cent. of those who left the works between January 1972 and April 1973 were redeployed either within the corporation or with other firms. For the 450 who now remain there are about 160 vacancies at Llanwern and 130 men will be retained for up to nine months on site clearance work. For those men who are prepared to move there are 600 vacancies in tubes division outside South Wales. In particular, there are opportunities for redeployment at Corby, where the tube making plant has an assured long-term future.
Thus there is a story of Government and management really caring and carrying through policies for dealing with redundancy problems and dealing with them in a way which really works. Indeed there is every reason to expect that the closure on 7th July will not produce a major increase in the number of unemployed in Newport. This is what Government policy set out to do and it will be a major achievement to bring it about.
The corporation made its decision in the exercise of its judgment to manage an efficient steel industry for Britain and has conducted itself in a most responsible manner. It is for the Government to support this decision and not shirk their responsibilities. It is only by such action that we will ever get a really modernised and competitive steel industry that can live with the rest of the world.
I realise the problems that this will bring for those who have worked at the Newport Tube Works. None the less, it is right that we should go forward in a way that will allow the corporation to provide the best steel industry in Britain that is humanly possible.

Question put and agreed to.

Adjourned accordingly at twenty-two minutes to Four o'clock.